2026 年第 2 期 第 21 卷

下腔静脉内径及变异率在心力衰竭液体管理中的临床应用进展

Clinical application progress of inferior vena cava diameter and variability in fluid management of heart failure

作者：吴蕾1韩红亚2刘晓丽2梁颖3

英文作者：Wu Lei1 Han Hongya2 Liu Xiaoli2 Liang Ying3

单位：1首都医科大学，北京100069；2首都医科大学附属北京安贞医院老年心血管病中心，北京100029；3首都医科大学附属北京安贞医院急诊危重症中心，北京100029

英文单位：1Capital Medical University Beijing 100069 China; 2Geriatric Cardiovascular Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 3Emergency and Critical Care Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：心力衰竭；液体管理；容量评估；下腔静脉；床旁超声

英文关键词：Heartfailure;Fluidmanagement;Volumeassessment;Inferiorvenacava;Point-of-careultrasound

• 摘要：

• 心力衰竭是心脏结构或功能异常从而导致心排血量下降或心腔压力升高的一类综合征，其核心病理机制之一为体液潴留。精准评估容量状态对于缓解患者症状、降低再入院风险具有重要意义。传统容量评估方法 如体格检查、利钠肽检测、右心导管检查等，存在准确性不足、侵入性强或操作成本高等问题。下腔静脉是人体最大直径的静脉系统，其形态及动态变化可反映人体的血流动力学状态。近年来，通过超声测量下腔静脉内径、计算下腔静脉变异率为无创评估血管内容量状态及指导液体管理提供了新工具，随着评估流程规范化和技术进步，下腔静脉参数在心力衰竭患者个体化液体管理中的临床价值日益凸显。

• Heart failure is a syndrome caused by abnormalities in cardiac structure or function, leading to decreased cardiac output or elevated intracardiac pressure, with fluid retention as one of its core pathological mechanisms. Accurate assessment of volume status is crucial for alleviating patient symptoms and reducing the risk of readmission. Traditional volume assessment methods, such as physical examination, natriuretic peptide testing, and right heart catheterization, have limitations. This includes in accuracies invasiveness, or high operational costs. The inferior vena cava (IVC) is the largest-diameter venous system in the human body, and its morphological and dynamic changes can reflect the body′s hemodynamic status. In recent years, ultrasound-based measurement of IVC diameter and calculation of IVC variability have provided a non-invasive tool for assessing intravascular volume status and guiding fluid management. With the standardization of assessment protocols and technological advancements, the clinical value of IVC parameters in individualized fluid management for patients with heart failure has become increasingly prominent.