慢性心力衰竭中容量超负荷和充血的评估与管理：测量血容量能否提供新见解？
Assessment and Management of Volume Overload and Congestion in Chronic Heart Failure: Can Measuring Blood Volume Provide New Insights?
作者信息
Miller Wayne L
机构信息
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn., USA.
出版信息
Kidney Dis (Basel). 2017 Jan;2(4):164-169. doi: 10.1159/000450526. Epub 2016 Oct 12.
Abstract
BACKGROUND
Volume overload and fluid congestion remain primary clinical challenges in the assessment and management of patients with chronic heart failure (HF).
SUMMARY
The pathophysiology of volume regulation is complex, and the simple concept of passive intravascular fluid accumulation is not adequate. The dynamics of interstitial and intravascular fluid compartment interactions and fluid redistribution from venous splanchnic beds to the central pulmonary circulation need to be taken into account in strategies of volume management. Clinical bedside evaluations and right heart hemodynamic assessments can alert 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 chronic HF. The quantitative assessment of intravascular volume is an effective tool to help guide individualized, appropriate therapy.
KEY MESSAGE
Not all volume overload is the same, and the measurement of intravascular volume identifies heterogeneity to guide tailored therapy.
摘要
背景
容量超负荷和液体潴留仍然是慢性心力衰竭（HF）患者评估和管理中的主要临床挑战。
总结
容量调节的病理生理学很复杂，单纯的血管内液体被动蓄积概念并不充分。在容量管理策略中，需要考虑间质和血管内液腔室相互作用的动态变化以及液体从内脏静脉床向肺循环中心的重新分布。临床床边评估和右心血流动力学评估可以提示容量状态的变化，但只有全血容量的定量测量才能帮助识别慢性HF容量超负荷特征的血浆容量和红细胞量的异质性。血管内容量的定量评估是帮助指导个体化、适当治疗的有效工具。
关键信息
并非所有的容量超负荷都是相同的，血管内容量的测量可识别异质性以指导个体化治疗。
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