medicina59巻12号

2022年11月発行

特集 避けて通れない心不全診療—総合内科力・循環器力を鍛えよう！ 急性心不全

うっ血の病態と評価について教えてください

著者： 猪又孝元¹

所属機関： ¹新潟大学大学院医歯学総合研究科循環器内科学

ページ範囲：P.2135 - P.2139

Point
◎心ポンプ異常により生ずる徴候は，うっ血が主である．
◎血管内うっ血を優先指標としてvolume管理を行うのが心不全治療の基本である．
◎頸静脈怒張は，血管内うっ血を示す身体所見である．
◎うっ血解除過程での低心拍出の可能性を意識しながら極力のうっ血解除を図り，臓器障害を防ぐ．

参考文献

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4）Yu CM, et al：Intrathoracic impedance monitoring in patients with heart failure；Correlation with fluid status and feasibility of early warning preceding hospitalization. Circulation 112：841-848, 2005

5）Miller WL, et al：Diuresis-related weight loss reflects interstitial compartment decongestion with minimal impact on intravascular volume expansion or outcomes in post-acute heart failure；Metrics of decongestion and volume status. J Card Fail 27：445-452, 2021

6）Fujiki S, et al：Body fluid regulation via chronic inhibition of sodium-glucose cotransporter-2 in patients with heart failure；A post hoc analysis of the CANDLE trial. Clin Res Cardiol 2022 ［Online ahead of print.］

7）Testani JM, et al：Timing of hemoconcentration during treatment of acute decompensated heart failure and subsequent survival；Importance of sustained decongestion. J Am Coll Cardiol 62：516-524, 2013

8）Fujita T, et al：Hemodilution after initial treatment in patients with acute decompensated heart failure. Int Heart J 59：573-579, 2018

9）Drazner MH, et al：Relationship of right- and left-sided filling pressures in patients with advanced heart failure；A 14-year multi-institutional analysis. J Heart Lung Transplant 31：67-72, 2012

10）Bhella PS, et al：Echocardiographic indices do not reliably track changes in left-sided filling pressure in healthy subjects or patients with heart failure with preserved ejection fraction. Circ Cardiovasc Imaging 4：482-489, 2011

11）Yoshioka K, et al：Impact of brain natriuretic peptide reduction on the worsening renal function in patients with acute heart failure. PLoS One 15：e0235493, 2020

12）Matsue Y, et al：Time-to-furosemide treatment and mortality in patients hospitalized with acute heart failure. J Am Coll Cardiol 69：3042-3051, 2017

13）Horiuchi Y, et al：Relation of decongestion and time to diuretics to biomarker changes and outcomes in acute heart failure. Am J Cardiol 147：70-79, 2021