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

摘要：

目的 分析心力衰竭患者入院1~7 d累积液体平衡量与血浆容量升高、淤血症状加重的相关性，探讨累积液体平衡量对预测心力衰竭患者容量负荷过重的应用价值。方法 采用便利抽样法，选取江苏省南京市、连云港市以及河南省驻马店市3所三级甲等综合医院2022年10月至2023年2月住院治疗的235例心力衰竭患者，根据血浆容量和淤血症状，将患者分为血浆容量降低组、血浆容量升高组以及淤血症状减轻组、淤血症状加重组。收集研究对象的一般资料、临床特征及1~7 d累积液体平衡量，比较各组累积液体平衡量的差异。采用Logistic回归分析比较累积液体平衡量对患者血浆容量和淤血症状的影响。采用受试者操作特征曲线分析累积液体平衡量预测血浆容量升高、淤血症状加重的最佳截断值。结果 剔除15例提前出院和3例液体出入量记录不准确的患者，共纳入患者217例，累积1 d液体正平衡发生率最低，为65.90%，累积量最少，为（0.235±0.983） L；累积6 d液体正平衡发生率最高，为75.58%，累积量最多，为（2.444±5.445） L。血浆容量升高组累积4~7 d的液体平衡量高于血浆容量降低组，差异具有统计学意义（P<0.05）；累积4~7 d的液体平衡量是血浆容量升高的独立影响因素，累积4~7 d的液体平衡量分别达到2.308、3.361、3.518、3.702 L时，可预测血浆容量升高，受试者操作特征曲线下面积分别为0.686、0.721、0.647、0.766。淤血症状加重组累积4~7 d的液体平衡量均高于淤血症状减轻组，差异具有统计学意义（P<0.05）；累积4~7 d的液体平衡量是淤血症状加重的独立影响因素，累积4~7 d的液体平衡量分别达到2.574、3.383、4.995、4.235 L时，可预测淤血症状加重，受试者操作特征曲线下面积分别为0.640、0.693、0.654、0.720。结论 心力衰竭患者累积液体正平衡发生率高，累积液体平衡量能够较好地预测容量负荷加重的发生，血浆容量增加先于淤血症状的出现。建议临床护理人员密切关注累积液体正平衡3 d以上的心力衰竭患者，当累积液体正平衡量超过2.308 L时，及时采取措施排出过多的液体，避免容量负荷过重的发生。

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