连续性静脉血液滤过治疗重度充血性心方衰竭临床效果观察

Clinical analysis of continuous venovenous hemofiltration in patients with severe congestive heart failure

目的评价不同原因的重度充血性心力衰竭应用连续性静脉血液滤过（CVVH）治疗的疗效。方法31例为无尿或少尿的重度充血性心力衰竭（心功能NYHA分级IV）患者，均给予床旁CVVH治疗，1次／d，每次6—10h，治疗前、后测定肾功能（BUN、Cr）、电解质（K^＋、Na^＋、Cl^-）、肝功能（AST）、左心室射血分数（LVEF）、平均动脉压（MBP）、心率。每天记录进出量。结果24例临床症状明显好转，其中9例肾功能完全恢复正常，生存率达77．42％（24／31）。1例因故终止治疗，6例1周内死亡。结论对于无尿或少尿的重度充血性心力衰竭在药物治疗同时行连续性静脉血液滤过的综合治疗，可取得明显疗效，降低病死率，是治疗重度充血性心力衰竭的有效方法。

Objective To analyze clinical outcome of continuous venovenous hemofihration （CVVH） in patients with severe congestive heart failure. Methods 31 cases of severe congestive heart failure （NYHA IV stage） were chosen. The serum BUN, Cr, K^＋ , Na^＋ Cl^- ,liver function index, and left ventricle ejection fraction （LVEF） as well as main blood pressure（MBP） and heart rate were monitored during the treatment and urinary volume were also recorded each day. Results 24 patients survived and their clinical symptoms were significantly improved, of whom renal function were completely recovered in 9 cases. One patient was stopped. Six patients died. Conclusion The patients with severe congestive heart failure treated by continuous venovenous hemofiltration combined with medicine treatment could acquire well curative effect. The therapy loweres mortality and is effective in the treatment of severe congestive heart failure.