Stevenson L W, Tillisch J H
Circulation. 1986 Dec;74(6):1303-8. doi: 10.1161/01.cir.74.6.1303.
Therapy of elevated ventricular filling pressures in patients with dilated heart failure may be limited by concern that cardiac output will be further compromised. Twenty-five patients with severe symptoms and ejection fractions of 25% or less were studied to determine the lowest ventricular filling pressures that could be achieved with vasodilator and diuretic therapy while maintaining cardiac output. In 20 of 25 patients normal pulmonary capillary wedge pressures (PCWs) were achieved (mean 10 mm Hg compared with 30 mm Hg at baseline). Stroke volume was 60 vs 39 ml at baseline. Stroke work index was 30 vs 19 g-m/m2. For each patient, over the range of PCWs, stroke volume and stroke work index were maintained and were often maximal at the lowest PCW achieved. The upright position was well tolerated in patients with normal supine PCW. Normal filling pressures can be achieved in patients with congestive heart failure without compromise of cardiac output. While congestive symptoms should be improved, the feasibility and benefit of maintaining normal filling pressures over a long term must be established.
扩张型心力衰竭患者心室充盈压升高的治疗可能会受到担心心输出量会进一步受损的限制。对25例有严重症状且射血分数为25%或更低的患者进行了研究，以确定在维持心输出量的同时，使用血管扩张剂和利尿剂治疗所能达到的最低心室充盈压。25例患者中有20例达到了正常的肺毛细血管楔压（PCW）（平均10 mmHg，而基线时为30 mmHg）。每搏量在基线时为39 ml，达到正常PCW时为60 ml。每搏功指数在基线时为19 g-m/m²，达到正常PCW时为30 g-m/m²。对于每例患者，在PCW范围内，每搏量和每搏功指数得以维持，且常在达到的最低PCW时最大。仰卧位PCW正常的患者能很好地耐受直立位。充血性心力衰竭患者可在不损害心输出量的情况下达到正常充盈压。虽然充血症状应会改善，但长期维持正常充盈压的可行性和益处仍有待确定。
