CAJ | 학술논문

目的评估超声测量下腔静脉(inferior vena cava,IVC)内径是否可作为一种客观指标衡量急性心力衰竭(acute heart failure,AHF)患者水潴留情况.方法研究对象为2013年12月至2014年4月间于首都医科大学附属北京友谊医院急诊科就诊诊断为AHF的患者.入组标准:患者有急性心力衰竭表现,辅助检查有心力衰竭的客观证据.排除标准:①既往有慢性肝脏疾病患者;②急性心肌梗死合并急性心力衰竭患者.应用Pearson相关分析进行相关性分析,以P＜0.05为差异具有统计学意义.结果 AHF组共收入72例患者,对照组收入22例患者,AHF组患者的水潴留评分较对照组明显增高(P＜0.05),同时IVC内径亦较对照组明显增高(P＜0.01),IVC内径与N末端脑钠肽原及水潴留评分均呈显著正相关(R =0.339,P=0.013;R=0.431,P=0.002),IVC内径与左室射血分数无明显相关性(R=0.241,P=0.102),但与肺动脉压、三尖瓣返流流速均呈明显正相关(R =0.414,P=0.004;R=0.359,P=0.015);与肌酐、尿素氮及总胆红素均呈明显正相关(R =0.313,P=0.032;R=0.379,P=0.009;R=0.385,P=0.007),与肾小球滤过滤呈明显负相关(R=-0.337,P=0.021).结论下腔静脉内径可作一项易测量的客观指标,结合临床表现更准确的评估AHF患者水潴留情况,指导临床治疗.
목적 평고초성측량하강정맥(inferior vena cava,IVC)내경시부가작위일충객관지표형량급성심력쇠갈(acute heart failure,AHF)환자수저류정황.방법 연구대상위2013년12월지2014년4월간우수도의과대학부속북경우의의원급진과취진진단위AHF적환자.입조표준:환자유급성심력쇠갈표현,보조검사유심력쇠갈적객관증거.배제표준:①기왕유만성간장질병환자;②급성심기경사합병급성심력쇠갈환자.응용Pearson상관분석진행상관성분석,이P＜0.05위차이구유통계학의의.결과 AHF조공수입72례환자,대조조수입22례환자,AHF조환자적수저류평분교대조조명현증고(P＜0.05),동시IVC내경역교대조조명현증고(P＜0.01),IVC내경여N말단뇌납태원급수저류평분균정현저정상관(R =0.339,P=0.013;R=0.431,P=0.002),IVC내경여좌실사혈분수무명현상관성(R=0.241,P=0.102),단여폐동맥압、삼첨판반류류속균정명현정상관(R =0.414,P=0.004;R=0.359,P=0.015);여기항、뇨소담급총담홍소균정명현정상관(R =0.313,P=0.032;R=0.379,P=0.009;R=0.385,P=0.007),여신소구려과려정명현부상관(R=-0.337,P=0.021).결론 하강정맥내경가작일항역측량적객관지표,결합림상표현경준학적평고AHF환자수저류정황,지도림상치료.
Objective To investigate the ultrasound measured inferior vena cava (IVC) caliber used as an objective indicator to assess water retention of patients with acute heart failure (AHF).Methods A total of 72 consecutive patients with acute heart failure admitted in the emergency department between December 2013 and April 2014 were enrolled.Acute heart failure was defined by the presence of symptoms such as asthmatic embarrassment and nocturnal paroxysmal dyspnea with or without signs of tracheobronchchial rale and edema of lower limbs,and by objective evidence of cardiac dysfunction as well,either a left ventricular ejection fraction (LVEF) ≤ 45％ or the combination of both left atrium dilation (≥ 4 cm diameter in the parasternal long axis) and a plasma concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP) ＞ 450 pg/mL (patients under 50 years old) or ＞ 900 pg/mL (patients over 50 years old and under 75 years old) or ＞ 1800 pg/mL (patients over 75 years old) or ＞ 1200 pg/mL (patients with renal dysfunction,glomerular filtration rate ＜ 60 mL/min).Exclusion criteria were chronic hepatic disease and acute myocardial infarction.Another 22 patients were enrolled as control.Independent t tests were used to compare normally distributed continuous variables between two groups,while nonparametric tests were used to compare non-normally distributed continuous ones,and chi-squared tests were used for categorical variables.The relations between IVC inner diameter and other normally distributed variables were assessed by Pearson correlation coefficients.A 2-sided P value ＜ 0.05 was considered statistically significant.Results The congestion score and IVC inner diameter were significantly higher in patients with AHF (P ＜ 0.05 ; P ＜ 0.01).The IVC inner diameter was correlated with NT-proBNP concentration (r =0.339,P =0.01 3) and congestion score (r =0.431,P =0.002).There was no relation between IVC inner diameter and LVEF (r =-0.241,P =0.102).IVC inner diameter had significantly positive correlations with pulmonary artery pressure and tricuspid regurgitation (r =0.414,P =0.004 ; r =0.359,P =0.015).Creatinine,blood urea nitrogen,and bilirubin were independently associated with increasing IVC inner diameter (r =0.313,P =0.032 ; r =0.379,P =0.009 ; r =0.385,P =0.007),while IVC inner diameter had negative relation with glomerular filtration rate (r =-0.337,P =0.021).Conclusions The IVC inner diameter can be used as a measurable and objective indicator to estimate the magnitude of access water retention in patients with AHF.