关键词: 心力衰竭, 容量状态, 累积液体平衡量, 血浆容量, 临床淤血评分, 护理

Abstract:

Objective To analyze the correlation between cumulative fluid balance volume and increasing plasma volume and aggravated clinical congestion symptoms in patients with heart failure on admission for 1~7 d，and to explore the application value of cumulative fluid balance volume in predicting volume overload. Methods Using the convenience sampling method，235 heart failure patients hospitalized from October 2022 to February 2023 in a total of 3 tertiary hospitals in Nanjing，Lianyungang，Jiangsu Province，and Zhumadian，Henan Province，were selected and classified into an increasing/decreasing plasma volume group and an aggravated/alleviated clinical congestion symptoms group. General information，clinical characteristics，and 1~7 d cumulative fluid balance volume of the study subjects were collected to compare the differences in cumulative fluid balance volume between the 2 groups. Logistic regression was used to analyze the effect of cumulative fluid balance volume on plasma volume and clinical congestion symptoms. Receiver operating characteristic curves were used to analyze the optimal cutoff value of cumulative fluid balance volume for predicting increasing plasma volume and aggravated clinical congestion symptoms. Results Excluding 15 patients who were discharged early and 3 patients with inaccurate records of fluid intake and excretion，a total of 217 patients were included. The incidence of positive fluid balance was lowest on day 1，at 65.90%，with the smallest cumulative volume of（0.235±0.983） L；the highest incidence of positive balance occurred on day 6，at 75.58%，with the largest cumulative volume of（2.444±5.445） L. The cumulative fluid balance at 4~7 d in the increasing plasma volume group was higher than that in the decreasing plasma volume group，and the difference was statistically significant（P<0.05）；the cumulative fluid balance at 4~7 d was an independent risk factor for plasma volume elevation，and a cumulative fluid balance of 2.308，3.361，3.518，and 3.702 L at 4~7 d was predictive of a plasma volume elevation，and areas under receiver operating characteristic curve were 0.686，0.721，0.647，and 0.766，respectively. The cumulative fluid balance for 4~7 d in the aggravated clinical congestion symptoms group was higher than that in the alleviated clinical congestion symptoms group，and the difference was statistically significant（P<0.05）；the cumulative fluid balance for 4~7 d was an independent risk factor for the aggravated clinical congestion symptoms，and a cumulative fluid balance for 4~7 d of 2.574，3.383，4.995，and 4.235 L predicted aggravated clinical congestion symptoms，and area under receiver operating characteristic curve was 0.640，0.693，0.654，and 0.720，respectively. Conclusion The incidence of cumulative positive fluid balance in heart failure patients is high，and the amount of cumulative fluid balance can better predict the occurrence of volume overload，and the increase of plasma volume precedes the appearance of clinical congestion symptoms. It is suggested that heart failure patients with more than 3 d of cumulative positive balance should be closely monitored，and when the cumulative positive balance exceeds 2.308 L，measures should be taken in time to drain excessive fluid，so as to avoid the incidence of volume overload.

Key words: Heart Failure, Volume Status, Cumulative Fluid Balance, Plasma Volume, Clinical Congestion Score, Nursing Care