持续静-静脉血液滤过治疗妊娠高血压疾病合并急性左心衰竭的疗效及安全性研究

Efficacy and safety study of continuous veno-venous hemofiltration in the treatment of pregnancy-induced hypertension complicated with acute left heart failure

目的探讨应用持续静静脉血液滤过(continuous veno-venous hemofiltration,CVVH)治疗妊娠高血压疾病合并急性左心衰竭的临床疗效及安全性。方法对26例确诊妊娠高血压疾病合并急性左心衰竭的患者在常规治疗效果不佳的基础上加用CVVH治疗,比较治疗前后患者生命体征和临床症状的改善情况、血浆B型利钠肽(B-type natriuretic peptide,BNP)的变化、超声心动图射血分数(ejection fraction,EF)的变化,并监测治疗过程中的并发症。结果经CVVH治疗后临床症状改善,心率和呼吸频率逐渐下降,脉搏血氧饱和度上升,血压逐渐下降,中心静脉压下降,与治疗前相比差异均有统计学意义(均P<0.01);治疗后BNP下降,患者左心室EF增加、左心室舒张末直径均较前有明显改善,差异有统计学意义(均P<0.05)。结论CVVH治疗妊娠高血压疾病合并急性左心衰竭可在短时间内缓解症状,改善心功能,且无严重并发症的发生,是一种安全而有效的治疗方法。

Objective To investigate the efficacy and safety of continuous veno-venous hemofiltration （CVVH） in the treatment of pregnancy-induced hypertension complicated with acute left heart failure. Methods Twenty-six pregnancy-induced hypertension patients complicated with acute left heart failure and without improvement after routine therapy were treated with CVVH combined with the routine therapy for at least 2 days. Their clinical manifestations, vital signs, plasma B-type natriuretic peptide （BNP）, and ejection fraction （EF） before and after CVVH treatment were compared. Complications during CVVH were also monitored. Results After CVVH, clinical symptoms improved in association with the decrease of heart rate, respiratory rate, blood pressure, central venous pressure and plasma BNP, and the increase of EF and arterial oxygen saturation. Meanwhile, left ventricle enddiastolic diameter （LVEDD） was also improved. No significant complications and acid-base imbalance were found after CVVH. Conclusions CVVH is an effective and safe method for the treatment of pregnancy-induced hypertension complicated with acute left heart failure. It can improve clinical symptoms and heart function in a short period of time without significant complications.