缓慢连续性超滤治疗合并肾衰的难治性心衰疗效评价

Research on congestive refractory heart failure with renal failure treated by slow continuous ultrafiltration and relationship between negative fluid balance and predicts prognosis

目的：观察缓慢连续性超滤（SCUF）治疗合并肾衰的难治性心衰的疗效及安全性,探讨液体平衡规律与治疗后并发症之间的相关性。方法：回顾性选择30例合并肾衰的难治性心衰患者,所有患者均采用深静脉置管后进行SCUF治疗,血流量为100~150 ml/min,治疗时间为24~48 h。同时利用脉搏指数连续心输出量监测（Pi CCO）进行血流力学参数监测及治疗前后血压、血氧饱和度、心率以及电解质的监测。结果：所有患者的血流动力学指标与治疗前比较均明显改善,心功能有显著改善,心率、血压稳定,血氧饱和度上升且无低血压发生,电解质紊乱改善,临床症状减轻。出现并发症和病死的患者术后2 d内总液体平衡量明显高于无并发症患者。结论：SCUF治疗合并肾衰的难治性心衰安全有效,治疗后早期的液体平衡情况与术后并发症的发生具有明显相关性。

Objective： To investigate the curative effect and safety of slow continuous ultrafiltration（SCUF） treatment on congestive refractory heart failure with renal failure, and to investigate the correlation between fluid balance and .the postoperative complications. Methods：Thirty patients with congestive refractory heart failure witll renal faiiure were chosen to receive slow continuous ultrafiltration treatment after deep vein catheterization, blood flow volume being 100-150 ml/min and therapy time being 24h. PiCCO was used to monitor the hemodynamic parameters, along with the change of blood pressure, blood oxygen saturation, heart beat and electrolyte. Results： After the slow continuous ultrafiltration treatment, the hemodynamic parameters of all patients showed obvious improvements, with better results on cardiac function and electrolyte balance. All the patients patients developed cardiopulmonary complications postoperatively have a larger total fluid balance of the first two days postoperatively than those without complications. Conclusion： SCUF have therapeutic effect and safety for treating congestive refractory heart failure with renal failure, and the status of the fluid balance can be a predictor of the postoperative morbidity and mortality.