连续性血液净化治疗顽固性心力衰竭患者35例结果分析

目的 探讨连续性血液净化(CBP)治疗顽固性心力衰竭(RHF)及对血浆血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)、心钠素(ANF)水平的影响。方法 应用CBP治疗35例RHF患者,检测治疗前后血压、心率、呼吸、血氧饱和度、血生化、血气分析、左心室射血分数(LVEF)及血浆AngⅡ、ALD、ANF等指标的变化和治疗效果。结果 应用CBP治疗后患者水肿明显减轻,收缩压、舒张压下降,心率、呼吸减慢,血氧饱和度升高,血清钾、钠、氯恢复正常,尿素氮及血肌酐下降;血pH值、血碳酸氢根升高,血氧分压升高,LVEF明显增加,心功能明显改善,血浆AngⅡ、ALD、ANF显著降低,统计学有明显差异。结论 CBP能有效纠正RHF患者水、电解质、酸碱平衡紊乱,降低血浆AngⅡ、ALD、ANF水平,纠正心力衰竭,短期效果佳。

Analyse in the patients with refractory heart purification treated by continuous blood purification

Objective To investigate the application of continuous blood purification (CBP) and the effect of the angiotensin Ⅱ (Ang Ⅱ), aldosterone (ALD), atrial natriuretic peptide (ANP) in plasma with refractory heart failure(RHF) treated by CBP. Methods 35 eases with RHF were treated by CBP. Blood pressure, heart rate, respiration, blood oxygen saturation, blood markers of biochemistry, blood gas analysis, left ventricle ejection fraction (LVEF), cardiac function and AnglI, ALD, ANF in plasma were checked before and after treatment. Results The systolic pressure, diastolic pressure, heart rate, respiration, serum creatinine, blood urea nitroge, Ang Ⅱ, ALD, ANF in plasm after treatment were signifycanfly lower than those before treatment of CBP (P<0.05, P<0.01). The pH, HCO₃-, PaO₂, LVEF after treatment were significantly higher than those before treatment of CBP (P<0.05, P<0.01). The edema of the patients was relieved, and the K+, Na+, Cl- of blood serum were recovered normal after treatment, and cardiac function was recovered(P<0.05, P<0.01). Conclusion In the patients with RHF, CBP can efficiently treat the water-electrolyte disturbance, keep the acid-base balance, decrease the levels of AngⅡ, ALD, ANF in plasma, clear the inflammatory mediator and improve cardiac function.