内脏神经阻滞介导心力衰竭应激血容量变化。
Splanchnic Nerve Block Mediated Changes in Stressed Blood Volume in Heart Failure.
机构信息
Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA.
Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA.
出版信息
JACC Heart Fail. 2021 Apr;9(4):293-300. doi: 10.1016/j.jchf.2020.12.006. Epub 2021 Mar 10.
OBJECTIVES
The authors estimated changes of stressed blood volume (SBV) induced by splanchnic nerve block (SNB) in patients with either decompensated or ambulatory heart failure with reduced ejection fraction (HFrEF).
BACKGROUND
The splanchnic vascular capacity is a major determinant of the SBV, which in turn determines cardiac filling pressures and may be modifiable through SNB.
METHODS
We analyzed data from 2 prospective, single-arm clinical studies in decompensated HFrEF (splanchnic HF-1; resting hemodynamics) and ambulatory heart failure (splanchnic HF-2; exercise hemodynamics). Patients underwent invasive hemodynamics and short-term SNB with local anesthetics. SBV was simulated using heart rate, cardiac output, central venous pressure, pulmonary capillary wedge pressure, systolic and diastolic systemic arterial and pulmonary artery pressures, and left ventricular ejection fraction. SBV is presented as ml/70 kg body weight.
RESULTS
Mean left ventricular ejection fraction was 21 ± 11%. In patients with decompensated HFrEF (n = 11), the mean estimated SBV was 3,073 ± 251 ml/70 kg. At 30 min post-SNB, the estimated SBV decreased by 10% to 2,754 ± 386 ml/70 kg (p = 0.003). In ambulatory HFrEF (n = 14) patients, the mean estimated SBV was 2,664 ± 488 ml/70 kg and increased to 3,243 ± 444 ml/70 kg (p < 0.001) at peak exercise. The resting estimated SBV was lower in ambulatory patients with HFrEF than in decompensated HFrEF (p = 0.019). In ambulatory patients with HFrEF, post-SNB, the resting estimated SBV decreased by 532 ± 264 ml/70 kg (p < 0.001). Post-SNB, with exercise, there was no decrease of estimated SBV out of proportion to baseline effects (p = 0.661).
CONCLUSIONS
The estimated SBV is higher in decompensated than in ambulatory heart failure. SNB reduced the estimated SBV in decompensated and ambulatory heart failure. The reduction in estimated SBV was maintained throughout exercise. (Splanchnic Nerve Anesthesia in Heart Failure, NCT02669407; Abdominal Nerve Blockade in Chronic Heart Failure, NCT03453151).
目的
作者评估了内脏神经阻滞（SNB）引起的失代偿或有症状射血分数降低的心力衰竭（HFrEF）患者的应激血容量（SBV）变化。
背景
内脏血管容量是 SBV 的主要决定因素，而 SBV 又决定了心脏充盈压，并且可以通过 SNB 改变。
方法
我们分析了两项前瞻性、单臂临床研究的数据，一项在失代偿性 HFrEF 患者中进行（内脏 HF-1；静息血流动力学），另一项在有症状的心力衰竭患者中进行（内脏 HF-2；运动血流动力学）。患者接受了侵入性血流动力学和局部麻醉的短期 SNB。使用心率、心输出量、中心静脉压、肺毛细血管楔压、收缩压和舒张压全身动脉压和肺动脉压以及左心室射血分数来模拟 SBV。SBV 以毫升/70 公斤体重表示。
结果
平均左心室射血分数为 21±11%。在失代偿性 HFrEF 患者（n=11）中，估计的平均 SBV 为 3073±251 毫升/70 公斤。SNB 后 30 分钟，估计的 SBV 下降 10%，至 2754±386 毫升/70 公斤（p=0.003）。在有症状的 HFrEF 患者（n=14）中，估计的 SBV 在静息时为 2664±488 毫升/70 公斤，在运动峰值时增加到 3243±444 毫升/70 公斤（p<0.001）。有症状的 HFrEF 患者的静息估计 SBV 低于失代偿性 HFrEF（p=0.019）。在有症状的 HFrEF 患者中，SNB 后，静息估计 SBV 下降 532±264 毫升/70 公斤（p<0.001）。SNB 后，随着运动，估计的 SBV 没有不成比例地低于基线效应（p=0.661）。
结论
失代偿性心力衰竭患者的估计 SBV 高于有症状的心力衰竭患者。SNB 降低了失代偿性和有症状心力衰竭患者的估计 SBV。在整个运动过程中，估计的 SBV 保持不变。（心力衰竭中的内脏神经麻醉，NCT02669407；慢性心力衰竭中的腹部神经阻滞，NCT03453151）。
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