下腔静脉变化比静脉压更敏感在液体清除期间：概念验证研究。

Changes in the Inferior Vena Cava Are More Sensitive Than Venous Pressure During Fluid Removal: A Proof-of-Concept Study.

机构信息

Laboratory of Echocardiography, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.

Department of Pharmacy Practice, Lipscomb University College of Pharmacy, Nashville, Tennesee, USA; Department of Pharmacy, Vanderbilt University Medical Center, Nashville, Tennesee, USA.

出版信息

J Card Fail. 2023 Apr;29(4):463-472. doi: 10.1016/j.cardfail.2022.09.012. Epub 2022 Oct 13.

DOI:10.1016/j.cardfail.2022.09.012

PMID:36243338

Abstract

BACKGROUND

Congestion is central to the pathophysiology of heart failure (HF); thus, tracking congestion is crucial for the management of patients with HF. In this study we aimed to compare changes in inferior vena cava diameter (IVCD) with venous pressure following manipulation of volume status during ultrafiltration in patients with cardiac dysfunction.

METHODS AND RESULTS

Patients with stable hemodialysis and with systolic or diastolic dysfunction were studied. Central venous pressure (CVP) and peripheral venous pressure (PVP) were measured before and after hemodialysis. IVCD and PVP were measured simultaneously just before dialysis, 3 times during dialysis and immediately after dialysis. Changes in IVCD and PVP were compared at each timepoint with ultrafiltration volumes. We analyzed 30 hemodialysis sessions from 20 patients. PVP was validated as a surrogate for CVP. Mean ultrafiltration volume was 2102 ± 667 mL. IVCD discriminated better ultrafiltration volumes ≤ 500 mL or ≤ 750 mL than PVP (AUC 0.80 vs 0.62, and 0.80 vs 0.56, respectively; both P< 0.01). IVCD appeared to track better ultrafiltration volume (P< 0.01) and hemoconcentration (P< 0.05) than PVP. Changes in IVCD were of greater magnitude than those of PVP (average change from predialysis: -58 ± 30% vs -28 ± 21%; P< 0.001).

CONCLUSIONS

In patients undergoing ultrafiltration, changes in IVCD tracked changes in volume status better than venous pressure.

摘要

背景

充血是心力衰竭（HF）病理生理学的核心；因此，跟踪充血对于 HF 患者的管理至关重要。在这项研究中，我们旨在比较在超滤过程中对容量状态进行操作后下腔静脉直径（IVCD）与静脉压的变化，研究对象为患有心功能障碍的患者。

方法和结果

研究纳入了稳定进行血液透析且存在收缩或舒张功能障碍的患者。在血液透析前后测量中心静脉压（CVP）和外周静脉压（PVP）。在透析前、透析期间的 3 次测量以及透析后即刻，同时测量 IVCD 和 PVP。在每个时间点，将 IVCD 和 PVP 的变化与超滤量进行比较。我们分析了 20 例患者的 30 次血液透析。PVP 被验证为 CVP 的替代物。平均超滤量为 2102±667mL。IVCD 与 PVP 相比，能更好地区分超滤量≤500mL 或≤750mL（AUC 0.80 与 0.62，和 0.80 与 0.56，均 P<0.01）。与 PVP 相比，IVCD 似乎能更好地跟踪超滤量（P<0.01）和血液浓缩（P<0.05）。IVCD 的变化幅度大于 PVP（从透析前开始的平均变化：-58±30%与-28±21%；P<0.001）。