连续性静脉-静脉血液滤过在48例难治性心力衰竭患者中的治疗作用

Effects of continuous veno-venous hemofiltration on patients with refractory heart failure

目的探讨连续性静脉-静脉血液滤过（CVVH）对难治性心力衰竭患者的治疗作用及安全性。方法48例难治性心力衰竭患者经常规强心、利尿等治疗效果不佳后接受CVVH治疗共167例次。观察治疗前后心率、血压、呼吸频率、肺部罗音、肝颈静脉回流征和水肿等的变化，并判断心功能的改变；测定治疗前、后左心室射血分数、肾功能及电解质等。结果经CVVH治疗后大部份患者（77．1％）呼吸困难缓解，心率逐渐恢复，血压维持正常，肺部罗音减少，肝颈静脉回流征转为阴性，水肿消退，左心室射血分数增加，心功能从Ⅳ级提高到Ⅱ～Ⅲ级；38例合并肾功能不全的患者经CVVH治疗后血尿素氮、肌酐降低；28例合并电解质紊乱者经治疗后高钾血症和低钠血症得到纠正。9例合并严重心律失常的患者有6例经CVVH治疗后心率、心律恢复正常。结论CVVH能平稳地清除水分及溶质并保持血流动力学的稳定，可以安全有效地应用于难治性心力衰竭的治疗。

Objective To investigate the efficacy and safety of continuous veno-venous hemofiltration （CVVH） on patients with refractory heart failure （RHF）. Methods The clinical manifestations and the laboratory parameters including heart rate, respiratory rate, blood pressure, edema, cardiac functional classification,left ventricle ejection fraction （LVEF） ,blood urea nitrogen （BUN） and serum creatinine （Set） were observed before and after the CVVH tretment in 48 patients with RHF were involved. Results After CVVH,the clinical symptoms and cardiac function of the most patients（77.1% ） were improved; The left ventricle ejection fractions were increased;BUN and Scr decreased;Hyperkalemia and hyponatremia corrected;6 patients with serious cardiac arrhythmias improved. Conclusion CVVH can keep homodynamics stable during removing excess water and it is an effective and safe method to treat refractory heart failure.