连续性静脉—静脉血液滤过在治疗顽固性心力衰竭中的应用

目的观察连续性静脉一静脉血液滤过(CVVH)治疗顽固性心力衰竭的疗效,探讨其在临床上的应用价值。方法 选取2010年1月一2013年12月黄河中心医院ICU收治的顽固性心力衰竭患者42例,随机分为治疗组和对照组各21例,治疗组患者在常规治疗心力衰竭基础上给予CVVH,观察2组患者的有效率、HR、CVP、BUN、SCr、LVEF、LVEDD、BNP、K⁺、Na+、Na⁺、CI+、CI^-等改善的情况。结果 治疗组总有效率为95.2%,明显高于对照组的52.4%,差异有统计学意义(P<0.01)。2组治疗后HR、CVP、BUN、SCr均显著下降,且治疗组低于对照组(P<0.05)。2组LVEF均上升,LVEDD及血清BNP均下降,差异有统计学意义,且治疗组低于对照组(P<0.05)。治疗后2组患者血钾、血钠、血氯水平均有改善,但仅治疗组差异有统计学意义(P<0.05),且治疗组优于对照组(P<0.05)。治疗组出现轻度出血1例,血压下降2例,对症处理后消失。结论 连续性静脉一静脉血液滤过治疗顽固性心力衰竭可提高效果,建议推广应用。

Continuous veno-venous hemofiltration in the treatment of refractory heart failure

Objective To observed continuous veno-venous hemofiltration（CVVH） therapy for refractory heart failure,and to explore its value in clinical practice.Methods From January 2010 to December 2013,selected 42 patients with refractory heart failure in admitted to the ICU of the Yellow River Central Hospital,they were randomly divided into treatment group and control group with 21 cases in each group,all patients in the treatment group with conventional therapy in addition,based on failure to carry out CWH,observed two groups efficiently,HR,CVP,BUN,SCr,LVEF,LVEDD,BNP,K^＋,Na^＋,Cl^- and other indexs improvement.Results Total effective rate was 95.2%in treatment group,which was significantly higher than 52.4%in control group,the difference was statistically significant（P〈0.01）.After treatment,HR,CVP,BUN,SCr were significantly decreased in the treatment group than the control group（P〈0.05）.2 groups＇ LVEF were increased,LVEDD and serum BNP were decreased,the difference was statistically significant,and the treatment group were better than the control group（P〈0.05）.2 groups＇ potassium,sodium,serum chloride levels were improved after treatment,but only the treatment group difference was statistically significant（P〈0.05）,and the treatment group were better than the control group（P〈0.05）.Treatment group had one case of mild bleeding,blood pressure decreased in two cases,after symptomatic treatment,these symptom were disappeared.Conclusion Continuous veno-venous hemofiltration treatment of refractory heart failure can improve outcome.