CAJ | 학술논문

目的探讨连续性静脉-静脉血液滤过(CVVH)在重症急性病毒性心肌炎(SAVM)中的疗效.方法对8例重症急性病毒性心肌炎的患者进行临床回顾性分析.所有患者均进行心电图、心脏超声、胸片和心肌酶谱、肌钙蛋白等心肌损伤标识物检查,根据病情需要部分患者行主动脉球囊反搏、置入临时起搏器及冠脉造影.在常规治疗基础上进行CVVH治疗并监测治疗前后心率等生命体征、生化指标、心肌酶谱、肌钙蛋白的变化及透析距临床诊断时间、透析速度、容量、持续时间等参数比较.结果 CVVH治疗后24 h 8例患者血流动力学趋于稳定,低血压、休克症状改善,HR在48 h、72 h改善明显(P<0.05),RR于CVVH后24 h即有明显改善(P<0.05),WBC于72 h改善明显(P<0.05),肝肾功能、心肌酶谱较治疗前明显改善(P<0.05),2例高钾血症透析后纠正,2例于CVVH停止治疗后3 d因室性心动过速、室颤死亡.结论重症急性病毒性心肌炎早期行CVVH治疗,可改善预后,降低病死率.
목적 탐토련속성정맥-정맥혈액려과(CVVH)재중증급성병독성심기염(SAVM)중적료효.방법 대8례중증급성병독성심기염적환자진행림상회고성분석.소유환자균진행심전도、심장초성、흉편화심기매보、기개단백등심기손상표식물검사,근거병정수요부분환자행주동맥구낭반박、치입림시기박기급관맥조영.재상규치료기출상진행CVVH치료병감측치료전후심솔등생명체정、생화지표、심기매보、기개단백적변화급투석거림상진단시간、투석속도、용량、지속시간등삼수비교.결과 CVVH치료후24 h 8례환자혈류동역학추우은정,저혈압、휴극증상개선,HR재48 h、72 h개선명현(P<0.05),RR우CVVH후24 h즉유명현개선(P<0.05),WBC우72 h개선명현(P<0.05),간신공능、심기매보교치료전명현개선(P<0.05),2례고갑혈증투석후규정,2례우CVVH정지치료후3 d인실성심동과속、실전사망.결론 중증급성병독성심기염조기행CVVH치료,가개선예후,강저병사솔.
Objective To evaluate the therapeutic effects of continuous veno - venous hemofiltration ( CVVH ) in treating severe acute viral myocarditis ( SAVM ). Methods We retrospectively analyzed 8 cases of SAVM in our department and reviewed our experiences in treating SAVM with CVVH. The following clinical variables were compared before and after CVVH:patients vital signs, serum biochemistry, myocardial enzymogram, ECG, echocardiography, critical conditions, special treatments including intra - aortic balloon pump (IABP) and pacemaker,and hemofiltration parameters including initiation time, filtration speed and volume and time. Results We found CVVH treatment significantly ameliorated patients' condition with most of the studied clinical variables outside normal range. Only two patients died of ventricular tachycardia and fibrillation on 3 th day after the cease of CVVH. Conclusion Early and prolonged use of CVVH is associated with the increase of survival rate and the decrease of mortality rate in SAVM.