血液透析治疗难治性充血性心力衰竭的体会

目的：了解血液透析治疗难治性充血性心力衰竭的可行性、治疗效果及安全性。方法：回顾性分析了经内科治疗无效或恶化而改用血液透析、超滤、脱水治疗的12例难治性充血性心力衰竭患者的情况。结果：12例患者均能耐受3h血透治疗；11例心衰得到纠正，抢救成功率91．7％；死亡1例，住院病死率8．3％；死因为心源性休克，未见血液透析急性并发症。结论：常规内科治疗无效的难治性充血性心力衰竭，合并肝、肾功能恶化，水、电解质、酸碱平衡紊乱的患者，行血液透析、超滤、脱水治疗是一种安全、有效的救治措施，成功率较高。

Effect of hemodialysis on refractory congestive heart failure

Objective: To explore the feasibility, effect and safety of hemodialysis on refractory congestive heart failure. Methods: A retrospective analysis was made on the 12 patients with refractory congestive heart failure, who had been given proper and sufficient medical treatment, with elimination of pathogenic factors and complication, but with further deterioration, and then were alternatively treated with hemodialysis, dehydration and ultrafiltration. Results: All the cases could tolerate 3-hour hemodialysis. Of the 12 cases with heart failure, 11 were corrected and only one case died of cardiogenic shock. In the course of treatment, no acute complication occurred. Conclusion: Hemodialysis coupled with ultrafiltration and dehydration is a safe and effective method for treatment of cases with refractory congestive heart failure, who showed no improvement after proper and sufficient medical treatment, but showed deterioration of kidney and liver functions, water-electrolyte imbalance and acid-base disturbance. The rate of success for this treatment is relatively high.