不同置换率的CVVH治疗急性心肌梗死并顽固性心衰的疗效及对神经内分泌系统的影响

目的探讨不同置换率的持续静脉-静脉血液滤过(CVVH)治疗急性心肌梗死合并顽固性心衰的临床效果及其对其神经内分泌系统的影响。方法 72例急性心肌梗死合并顽固性心衰患者在常规治疗的基础上给予CVVH治疗,按CVVH治疗置换率不同分为A、B两组,观察两组治疗前后心衰临床表现及心功能心脏指数的变化,并测定治疗前后6、12h左心室射血分数、动脉血气分析、血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、血醛固酮(ALD)、肿瘤坏死因子(TNF-α)、血生化指标及血电解质变化。结果两组患者经CVVH治疗后临床症状得到改善或消失,左心室射血分数显著增加,心功能改善;其中B组总有效率显著高于A组(85.7%VS80%,P<0.05);两组患者血流动力学指标稳定,氧合指数和呼吸频率、心率、平均动脉压、心脏指数(CI)明显改善(P<0.05或P<0.01),其中B组的变化更为显著(P<0.05或P<0.01);两组患者治疗后部分神经内分泌激素如PRA、Ang-Ⅱ、ALD和炎症因子TNF-α等均有明显降低(P<0.05或P<0.01),其中B组的变化更为显著(P<0.05或P<0.01)。结论 CV-VH治疗不失为急性心肌梗死合并顽固性心衰的有效治疗方法 ,高置换率CVVH治疗较低置换率CVVH治疗能更有效的保持患者血流动力学的稳定、能更有效的清除部分神经内分泌激素和炎症因子,因而更有利于改善顽固性心衰。

Treatment of CVVH therapy with different replacement rates on patient with acute myocardial infarction complicated intractable heart failure and its effect on patient’s neuroendocrine system

Objective To evaluate in the treatment of continuous veno-venous hemofiltration(CVVH)therapy with different replacement rates on patient with acute myocardial infarction complicated with intractable heart failure and its effect on patient’s neuroendocrine system.Methods 72 patients with acute myocardial infarction(AMI) complicated with intractable heart failure(IHF)were cured with CVVH combining with regular treatment of Cardiotonics,Diuretics,and Vasodilators.The patients were divided into two groups according to the difference in the replacement rate of CVVH used,namely Group A and Group B.Heart failure clinical manifestation and changes in cardiac index was observed before and after CVVH,the measured left ventricular ejection fraction,arterial blood gas analysis,PRA,AngⅡ,ALD,TNF-α,blood biochemical index and changes of serum electrolyte were recorded at the time before CVVH and 6,12 h after CVVH.Results After CVVH treatment,the clinical symptoms were improved or disappeared,left ventricular ejection fraction was increased significantly and cardiac function was improved in the patients from both groups.The difference of effective rate in CHHV in B group compared with A group had statistical significance(85.7% VS 80%,P<0.05).After CVVH treatment,the measured hemodynamics was stable and oxygenation index and respiration frequency,heart rate,mean arterial pressure,cardiac index were improved significantly(P<0.05 or P<0.01).The improvement in the patient of B group was more conspicuous(P<0.05 or P<0.01).After CVVH treatment,some neuroendocrine hormones including PRA,Ang-Ⅱ,ALD and TNF-α were decreased significantly(P<0.05 or P<0.01).The reduction of hormones in the patient of B group was more conspicuous(P<0.05 or P<0.01).Conclusion CVVH treatment is still an effective method for patient with AMI complicated with IHF.CVVH with high replacement rate could benefit the stability of hemodynamics,removal of some neuroendocrine hormones and inflammatory factors,thus conducive to the improvement of intractable heart failure.