Abstract:

Objective To investigate the effect of average daily fluid balance（AFB） on plasma volume in heart failure patients stratified by left ventricular ejection fraction（LVEF） and estimated glomerular filtration rate（eGFR），and to identify safe AFB thresholds for each subgroup. Methods A convenience sample of 477 patients hospitalized with heart failure between March 2023 and June 2024 was recruited from 3 tertiary general hospitals in Nanjing and Lianyungang（Jiangsu Province） and Zhumadian（Henan Province）. Patients were classified into 4 groups based on LVEF and eGFR：a normal for both indicators group，a reduced eGFR only group，a reduced LVEF only group，and a both indicators abnormal group. General demographic and clinical data，AFB，and changes in plasma volume were collected. Intergroup differences were compared，and Pearson and Spearman correlation analyses were performed to assess the relationships between these variables. Linear regression was used to further analyze the associations，and receiver operating characteristic（ROC） curves were generated to determine the optimal AFB thresholds for each group. Results After excluding 17 patients with inaccurate fluid intake/output records，460 patients were included in the final analysis. In the normal group，AFB had no statistically significant effect on plasma volume（P>0.05）. In the reduced eGFR group，reduced LVEF group，and both indicators abnormal group，AFB was positively correlated with plasma volume（P<0.05），with respective upper AFB threshold limits of 193.75，579.25，94.75 mL. Conclusion Heart failure patients with different cardiac and renal functional profiles exhibit markedly different tolerances to fluid load. Nursing staff should consider both LVEF and eGFR when developing individualized fluid management strategies to prevent excessive plasma volume expansion.

Key words: Heart Failure, Fluid Balance, Plasma Volume, Stroke Volume, Glomerular Filtration Rate, Nursing Care

摘要：

目的 观察日均液体平衡量对不同左心室射血分数（left ventricular ejection fraction，LVEF）与估算肾小球滤过率（estimated glomerular filtration rate，eGFR）分组的心力衰竭患者估计血浆容量状态的影响，探索各类患者液体平衡量安全阈值。方法 通过便利抽样，选择江苏省南京市、连云港市以及河南省驻马店市3所三级甲等综合医院2023年3月至2024年6月住院治疗的477例心力衰竭患者为调查对象，根据LVEF和eGFR分为双指标正常组、eGFR降低组、LVEF降低组、双指标异常组。收集调查对象的一般资料、日均液体平衡量与估计血浆容量状态变化值，比较四组的差异，使用Pearson检验、Spearman检验分析一般资料、日均液体平衡量与估计血浆容量状态之间相关性，并通过线性回归进一步分析，生成受试者操作特征曲线，以确定四组日均液体平衡量的阈值。结果 剔除17例液体摄入和排出量记录不准确的患者，最终纳入患者460例，双指标正常组日均液体平衡量对血浆容量影响无统计学意义（P>0.05）。eGFR降低组、LVEF降低组、双指标异常组的日均液体平衡量与估计血浆容量状态呈正相关（P<0.05），各组的日均液体平衡量阈值上限分别为193.75、579.25、94.75 mL。结论 不同心肾功能状态心力衰竭患者对液体负荷的耐受性存在差异，护士应结合LVEF与eGFR指标，制订个体化液体管理策略，以防止血浆容量的过度扩张。

关键词: 心力衰竭, 液体平衡量, 血浆容量, 每搏输出量, 肾小球滤过率, 护理