Department of Cardiology, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham HU16 5JQ, UK.
Nat Rev Cardiol. 2013 Mar;10(3):156-70. doi: 10.1038/nrcardio.2012.191. Epub 2013 Jan 15.
Oedema is one of the fundamental features of heart failure, but the pathophysiology of oedema varies. Patients present along a spectrum ranging from acute pulmonary oedema to gross fluid retention and peripheral oedema (anasarca). In patients with pure pulmonary oedema, the problem is one of acute haemodynamic derangement; the patient does not have excess fluid, but pulmonary venous pressure rises such that the rate of fluid transudation into the interstitium of the lung exceeds the capacity of the pulmonary lymphatics to drain away the fluid. Conversely, in patients with peripheral oedema, the problem is one of fluid retention. Understanding the causes of oedema will enable straightforward, correct management of the condition. For patients with acute pulmonary oedema, vasodilatation is important to reduce cardiac filling pressures. For patients with fluid retention, removing the fluid, using either diuretics or mechanical means, is the most important consideration.
水肿是心力衰竭的基本特征之一，但水肿的病理生理学机制有所不同。患者表现为从急性肺水肿到大量液体潴留和外周水肿（全身性水肿）的连续谱。在单纯性肺水肿患者中，问题是急性血流动力学紊乱；患者没有多余的液体，但肺静脉压升高，导致液体渗出到肺间质的速度超过肺淋巴管排出液体的能力。相反，在外周水肿患者中，问题是液体潴留。了解水肿的原因将有助于对该病症进行简单、正确的管理。对于急性肺水肿患者，血管舒张对于降低心脏充盈压很重要。对于液体潴留患者，最重要的考虑因素是去除液体，无论是使用利尿剂还是机械手段。
