连续性血液净化治疗难治性心力衰竭

CONTINUOUS BLOOD PURIFICATION IN THE TREATMENT OF REFRACTORY CONGESTIVE HEART FAILURE

目的观察连续性血液净化(continuous blood purification,CBP)技术治疗难治性心力衰竭患者的临床疗效。方法采用美国 Baxter BM25 床旁血滤机,Fresenius Polysulfone AV600S 血滤器。置换液采用南京军区总院配方,置换液流量2～3 L/h。前稀释法,血流量150～220 mL/min,低分子肝素首剂15～20 U/kg 静脉注射抗凝,此后追加7.5～10.0U/kg·h^(-1)。24 h 连续治疗,持续2～10d。连续治疗8 h 更换血滤器、血滤管路。同时针对原发病给予病因治疗,患者病情好转,改为 CBP 6～12 h/d,再改为药物治疗。结果 15例患者显效11例,有效3例,无效1例,总有效率93.3%。结论 CBP 技术治疗难治性心力衰竭患者临床症状改善明显,不良反应发生率低。

Objective To evaluate the clinical value of continuous blood purification（CBP） technique in the treatment of refractory congestive heart failure. Methods Continuous bedside hemofihration was performed with Baxter BM25 with a polysulfone AV 600S membrane in 15 patients with refractory congestive heart failure. The composition of substitution fluid is according to the formula of Nanjing PLA General Hospital, with a substitution volume of 2 ~ 3 L/h. The treatment pattern adopted is anterior dilution method,the blood volume is 150-220 mL/min. To use low molecular heparin with first dosage of 15-20 U/kg ivgtt to anticoagulate,later add 7.5- 10 U/kg·h^-1 more and undergo for 24 h continuous treatment and lasting for 2-10 d. After 8 h continuous treatment then change membrane of hemofilter used in CBP and hemofiltration access. Meanwhile treat the cause of disease according to the primary disease. If the condition of disease is improved,then use CBP for 6~12 h and change for drug treatment. Results Of 15 patients ,11 of them are obviously effective, 3 are effective, one is of non-effecive. The general rate of effectiveness is 93.3 %. Conclusion CBP technique can obviously improve the clinical symptoms of congestive heart failure and with low rate of oecurence of side effects.