Miller Wayne L
From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Circ Heart Fail. 2016 Aug;9(8):e002922. doi: 10.1161/CIRCHEARTFAILURE.115.002922.
Volume regulation, assessment, and management remain basic issues in patients with heart failure. The discussion presented here is directed at opening a reassessment of the pathophysiology of congestion in congestive heart failure and the methods by which we determine volume overload status. Peer-reviewed historical and contemporary literatures are reviewed. Volume overload and fluid congestion remain primary issues for patients with chronic heart failure. The pathophysiology is complex, and the simple concept of intravascular fluid accumulation is not adequate. The dynamics of interstitial and intravascular fluid compartment interactions and fluid redistribution from venous splanchnic beds to central pulmonary circulation need to be taken into account in strategies of volume management. Clinical bedside evaluations and right heart hemodynamic assessments can alert clinicians of changes in volume status, but only the quantitative measurement of total blood volume can help identify the heterogeneity in plasma volume and red blood cell mass that are features of volume overload in patients with chronic heart failure and help guide individualized, appropriate therapy-not all volume overload is the same.
容量调节、评估和管理仍然是心力衰竭患者的基本问题。本文的讨论旨在重新评估充血性心力衰竭中充血的病理生理学以及我们确定容量超负荷状态的方法。对经过同行评审的历史和当代文献进行了综述。容量超负荷和液体充血仍然是慢性心力衰竭患者的主要问题。其病理生理学很复杂，血管内液体蓄积的简单概念并不充分。在容量管理策略中，需要考虑间质和血管内液体腔室相互作用的动态变化以及液体从内脏静脉床向中央肺循环的重新分布。临床床边评估和右心血流动力学评估可以提醒临床医生容量状态的变化，但只有全血容量的定量测量才能帮助识别慢性心力衰竭患者容量超负荷特征的血浆容量和红细胞量的异质性，并有助于指导个体化的适当治疗——并非所有的容量超负荷都是相同的。
