连续静脉-静脉血液滤过治疗顽固性充血性心力衰竭

目的观察连续静脉-静脉血液滤过（CVVH）治疗顽固性充血性心力衰竭（CHF）的临床疗效及其对血管紧张素Ⅱ（AngⅡ）、脑钠钛（BNP）和炎性细胞因子水平的影响。方法将29例纽约心脏病学会（NYHA）心功能Ⅳ级CHF患者，根据是否接受CVVH分成CVVH组（14例）和对照组（15例），对照组予以心力衰竭常规治疗，CVVH组在常规药物治疗的基础上给予CVVH治疗。检测两组治疗前后内环境生化指标，AngⅡ、BNP和肿瘤坏死因子（TNF—α）、白细胞介素-1（IL-1）、白细胞介素-6（IL-6）、C反应蛋白（CRP）炎症水平的变化；观察两组心功能指标和临床转归。结果CwH组外周血中尿素氮（BUN）、肌酐（Cr）、TNF—α、IL-1、IL-6、CRP、AngⅡ、BNP水平较治疗前明显下降，且明显低于对照组（P〈0．05或P〈0．01）。结论CVVH可以有效地用于治疗顽固性心力衰竭及其并发的高度水肿、电解质紊乱及酸碱平衡失调；CVVH能清除具有心血管活性的中分子炎症介质、心脏抑制因子及过度激活的神经内分泌激素。

Clinical Observation of Study on Continuous Veno - venous Hemofiltration in Patients with Refractory Congestive Heart Failure

Objective To observe the effect of continuous veno - venous hemofiltration （CVVH） on refractory congestive heart failure （CHF） and to analyze the plasma levels of cytokines and angiotensin Ⅱ （AngⅡ ） and brain natriuretic peptide （BNP）. Methods Twenty - nine patients （pts） with refractory CHF and NYHA heart function class Ⅳ were divided into control group （n= 15） treated with routine treatment and CVVH group （n = 14） treated by CVVH with routine treatment. Left ventricular ejective fraction （LVEF）, cardiac index （CI） as well as the levels of blood urea nitrogen （BUN）, creatinine （Cr）, Ang Ⅱ , BNP, cytokines and C - reactive protein（CRP）were evaluated. Results Compared with the control group, the plasma levels of BUN,Cr, Ang Ⅱ , BNP, interleukin （IL）- 1β,IL- 6 ,tumor necrosis factor-α （TNF- α） and CRP in CVVH group were decreased significantly after treatment （P〈0.05 or P〈0.01）. Conclusion CVVH was effective for refractory CHF and its complications such as high edema,the electrolyte disturbanee and acid - base imbalance. CVVH could keep stable hemodynamies during removing neurohormonal,cytokines and myocardial depressant factors from the blood.