连续性血液净化治疗顽固性心力衰竭和清除炎症介质临床研究

目的探讨应用持续静静脉血液滤过(continuous veno-venous hemofiltration,CVVH)技术对顽固性心力衰竭患者炎症介质水平的影响。方法 19例顽固性心力衰竭患者经右侧股静脉插管留置单针单腔导管,行CVVH模式治疗。于CVVH治疗前后,检测血液电解质和肾功能,于CVVH治疗前和治疗后1、2、4、6、8h抽取静脉血液检测炎症介质,其中采用酶联免疫吸附法测定有关炎症介质因子。观察心功能指标和临床转归。结果19例患者CVVH后血尿素氮、血清肌酐和K+均下降(P<0.05);肿瘤坏死因子á、白细胞介素6和白细胞介素8水平降低(P<0.05);左心室射血分数、心输出量和心脏指数均明显提高(P<0.05);治疗后纽约心脏病学会心功能分级为Ⅰ级2例,Ⅱ级13例,Ⅲ级4例;显效15例(78.8%),有效4例(21.2%),除个别患者出现轻微头晕、恶心等,均无严重并发症出现。结论 CVVH能清除顽固性心力衰竭患者血浆多种炎症介质因子,并可降低血尿素氮、血清肌酐和K+水平,改善心功能和预后。

Clinical investigation of continuous veno-venous hemofiltration on refractory heart failure and clearance of inflammatory mediators

Objective To investigate the effects of continuous veno-venous hemofiltration(CVVH) on the levels of inflammatory mediators in patients with refractory heart failure.Methods Nineteen patients fulfilled the criteria of refractory heart failure were recruited in this study.A single lumen catheter was indwelled into the right femoral vein,and CVVH was performed.Blood biochemical markers including electrolytes,urea nitrogen(BUN),creatinine(Cr) and plasma inflammatory mediators were measured at 0,1,2,4,6 and 8h ...