难治性充血性心衰患者水钠潴留的CVVH治疗疗效和护理难点临床分析

The clinical therapeutic effect and nursing care of continuous veno-venous hemofiltration in the management of fluid-overloaded refractory congestive heart failure

目的:评价连续性静脉-静脉血液滤过(CVVH)治疗难治性充血性心衰患者水钠潴留的疗效,总结CVVH的护理经验,为难治性心衰患者的治疗提供更好的医护帮助。方法:收集2009年3月～2010年3月我院CCU住院治疗的难治性心衰水钠潴留患者57例,其中行CVVH治疗的26例为治疗组,行常规治疗的31例为对照组,观察治疗前后的体重变化、心衰症状改善情况及血液动力学和实验室检测指标的变化情况。结果:CVVH治疗48h的体重变化和心衰症状改善均优于对照组(均P<0.01),患者对CVVH治疗耐受良好,安全有效,无严重的治疗并发症。结论:CVVH治疗充血性心力衰竭患者水钠潴留的近期疗效是有效的和安全的,但需要更大的样本量来进一步证实这一结论。护理是CVVH治疗中至关重要的环节,尤其要注意低血压和离子、酸碱失衡的出现。

Objective：To assess the safety and efficacy of continuous veno-venous hemofiltration（CVVH）in fluid-overloaded patients admitted with refractory congestive heart failure.And to summarize the experiences of nursing care in CVVH.Methods：Data were obtained from the department of CCU in our hospital.57 fluid-overloaded patients with refractory congestive heart failure（RCHF）from March 2009 to March 2010 were recruited.26 patients were treated by CVVH.The clinical data were collected.Results：After 48 h of treatment,the fluid removal and weight loss was statistically greater in the CVVH group than usual care group（P〈0.01）.CHF symptoms were significantly improved in the CVVH group compared to usual care at 48 h.Conclusion：The application of CVVH for patients with RCHF was feasible,well-tolerated.A larger trial is underway to determine the relative efficacy of CVVH versus standard care in RCHF.Nursing care is one of the most important aspects in CVVH.We should pays great attention to the hypotension and maintain the acid-base balance and maintain the balance of electrolyte and acid-base.