超声血流动力学在老年急性心力衰竭患者容量管理中的运用

The use of hemodynamic ultrasound in the management of blood volume in elderly patients with acute heart failure

目的运用超声血流动力学检查老年急性心力衰竭(AHF)患者容量状态, 并评估临床治疗后效果。方法回顾性分析我院收治的2020年6月至2022年6月老年AHF患者, 运用超声评估存在容量过负荷并给予及时相应治疗者32例为A组, 临床医师根据临床指标评估容量状态并立即给予相应治疗者32例为B组, 比较超声明确患者容量过负荷状态与临床评估容量过负荷状态所需时间差异, 自诊断AHF两组给予治疗48 h后, 分析两组患者生命体征临床参数、检验项目及超声血流动力学指标的差异。结果 A组超声明确容量过负荷所需时间明显短于B组临床评估出患者容量过负荷所需时间, 两组差异有统计学意义[(1.08±0.34)h比(9.21±2.57)h, t=-17.722, P<0.05]。治疗48 h后A组生命体征临床参数心率、呼吸频率明显低于B组[(87.87±4.38)次/min、(20.78±2.28)次/min比(94.78±6.53)次/min、(24.15±2.02)次/min, P<0.05];A组实验室项目脑钠肽(BNP)低于B组[(1122.00±132.07)ng/L比(1301.13±217.94)ng/L, P<0.05];A组超声血流动力学指标二尖瓣流入侨乡期E波与内侧产生的舒张早期组织多普勒e’波比值E/e’(15.69±2.79)、下腔静脉内径(IVC)(1.77±0.16)cm、超声肺部评分(LUS)与B组对比差异有统计学意义[(11.03±1.15)分比(12.13±1.70)分, P<0.05]。进行Logistic回归分析显示呼吸频率、E/e’、IVC是评估患者容量过负荷的独立预测因素, 分别为呼吸频率(OR=1.650, 95%CI:1.104~2.466, P=0.015), E/e’(OR=1.631, 95%CI:1.065~2.498, P=0.024), IVC(OR=1.714, 95%CI:1.250~2.349, P=0.001)。结论运用超声血流动力学能较早评估老年AHF患者的容量状态, 早期给予治疗后病情改善较好, 可以作为指导临床早期容量管理的循证依据, 值得临床推广。

Objective To use hemodynamic ultrasound to monitor the blood volume of elderly patients with acute heart failure(AHF)and to assess the outcome of clinical treatment.Methods In this retrospective analysis,elderly patients with AHF treated at our hospital between June 2020 and June 2022 were divided into two groups,with 32 in Group A assessed by ultrasound for volume overload and given timely treatment where appropriate and 32 in Group B assessed by physicians for volume overload using clinical parameters and given timely treatment where appropriate.Differences in the time required to ascertain volume overload between assessment based on ultrasound and assessment based on clinical parameters were compared.Additionally,differences in values of patients'vital sign parameters,laboratory tests and hemodynamic ultrasound parameters after 48-hour treatment since the diagnosis of AHF were also analyzed.Results The time required for ultrasound diagnosis of volume overload in Group A was significantly shorter than in Group B,and the difference between the two groups was statistically significant[(1.08±0.34)h vs.(9.21±2.57)h,t=-17.722,P<0.05].After 48 hours of treatment,the heart rate and respiratory rate(RR)in Group A were significantly lower than those in Group B[(87.87±4.38)times/min,(20.78±2.28)times/min us.(94.78±6.53)times/min,(24.15±2.02)times/min,respectively,P<0.05].The brain natriuretic peptide(BNP)in Group A was significantly lower than that in Group B[(1122.00±132.07)ng/L us.(1301.13±217.94)ng/L,P<0.05];In Group A,parameters such as the ultrasound hemodynamic index E/e'(15.69±2.79),inferior vena cava(IVC)diameter(1.77±0.16)cm,lung ultrasound score(LUS)(11.03±1.15)points us.(12.13±1.70)points showed statistically significant differences,compared with group B(P<0.05).Logistic regression analysis showed RR(OR=1.650,95%CI:1.104-2.466,P=0.015),E/e'(OR=1.631,95%CI:1.065-2.498,P=0.024),andIVC(OR=1.714,95%CI:1.250-2.349,P=0.001)were independent predictors for the assessment of volume overload.Conclusions Hemodynamic ultrasound can be used to assess the early volume status of elderly patients with AHF,serve as an evidence-based tool for guiding early clinical volume management,and should be recommended in clinical practice.