CAJ | 학술논문

目的观察不同速率的持续静脉-静脉血液滤过(CVVH)治疗难治性心力衰竭(IHF)的临床疗效.方法 50例难治性心力衰竭患者在常规治疗的基础上给予CVVH治疗,按CVVH不同治疗速率分为A、B两组,测定治疗前后血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、血醛固酮(ALD)、血浆B型钠尿肽(BNP)、动脉血气分析及血生化指标变化；观察两组患者治疗前后心力衰竭临床表现及心功能的变化.结果两组患者治疗后神经内分泌激素PRA、Ang-Ⅱ、ALD、BNP等均有明显降低(P＜0.05),其中A组的变化更为显著(P＜0.05).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(LVEF)显著增加,心功能改善,其中A组总有效率为88％,B组为80％,差异有统计学意义(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),其中A组的变化较B组更为显著(P＜0.05).结论 CVVH是难治性心力衰竭的有效治疗方法,CVVH高速率治疗较低速率治疗能更有效地清除一些神经内分泌激素,稳定患者血流动力学,改善难治性心力衰竭患者的心功能.
목적 관찰불동속솔적지속정맥-정맥혈액려과(CVVH)치료난치성심력쇠갈(IHF)적림상료효.방법 50례난치성심력쇠갈환자재상규치료적기출상급여CVVH치료,안CVVH불동치료속솔분위A、B량조,측정치료전후혈장신소활성(PRA)、혈관긴장소Ⅱ(AngⅡ)、혈철고동(ALD)、혈장B형납뇨태(BNP)、동맥혈기분석급혈생화지표변화；관찰량조환자치료전후심력쇠갈림상표현급심공능적변화.결과 량조환자치료후신경내분비격소PRA、Ang-Ⅱ、ALD、BNP등균유명현강저(P＜0.05),기중A조적변화경위현저(P＜0.05).량조환자경CVVH치료후림상증상득도개선혹소실,좌심실사혈분수(LVEF)현저증가,심공능개선,기중A조총유효솔위88％,B조위80％,차이유통계학의의(P＜0.05).량조환자혈류동역학지표은정,양합지수화호흡빈솔、심솔、평균동맥압、심장지수(CI)명현개선(P＜0.05),기중A조적변화교B조경위현저(P＜0.05).결론 CVVH시난치성심력쇠갈적유효치료방법,CVVH고속솔치료교저속솔치료능경유효지청제일사신경내분비격소,은정환자혈류동역학,개선난치성심력쇠갈환자적심공능.
Objective To observe the effects of continuous veno-venous hemofiltration (CVVH) therapy with different replacement rates on patients with intractory heart failure (IHF).Methods Fifty patients with refractory heart failure were given CVVH treatment based on conventional treatment.The patients were divided into group A and group B according to the difference replacement rate of CVVH.Plasma renin activity (PRA),angiotensin Ⅱ(Ang Ⅱ),aldosterone (ALD),B-type natriuretic peptide (BNP),changes of serum electrolyte and arterial blood gas analysis were recorded before and after CVVH.The clinical manifestation and cardiac function of patients with heart failure before and after treatment was observed.Results After CVVH treatment,the neuroendocrine hormones PRA,Ang-Ⅱ,ALD and BNP in both groups decreased significantly (P ＜ 0.05),group A was more significant (P ＜ 0.05).The clinical symptoms were improved or dispeared,left ventricular ejection fraction increased significantly and cardiac function improved in the two groups after CVVH treatment.The total efficiency rate in group A was 88％,in group B was 80％,the difference was statistically significant (P ＜ 0.05).The hemodynamic parameters was stable and oxygenation index and respiration frequency,heart rate,mean arterial pressure,cardiac index were improved significantly (P ＜ 0.05),and group A was more significant (P ＜ 0.05).Conclusions CVVH treatment was an effective method for patients with IHF.CVVH with high replacement rate can be more effective to remove some of neuroendocrine hormones,stable hemodynamics,improve cardiac function of patients with intractable heart failure.