单纯超滤治疗急性心肌梗死后心衰疗效分析

Isolated ultrafiltration for treatment of cardiac insufficiency in patients with acute myocardial infarction

目的探讨单纯超滤对急性心肌梗死后心功能不全患者的疗效分析。方法收集2010年8月至2014年8月在河南省人民医院急诊科住院的急性心肌梗死患者，其中102例在急诊介入治疗、开通罪犯血管后出现急性心功能不全。全部患者首先采用内科常规治疗，分为2组，1组标准药物治疗，另1组在标准药物治疗下行单纯超滤治疗。同组患者不同时间点间的比较采用重复测量方差分析；2组患者间同一时点的监测指标、监护时间和住院时间的比较采用成组t检验。2组患者病死率的比较采用x。检验。以P〈0．05为差异有统计学意义。结果51例常规药物治疗患者，急性左心衰竭发作次数逐渐减少，电解质逐渐维持于正常水平，但改善情况均较单纯超滤组缓慢。4例死于心源性猝死。随访至发病后1年，14．89％（7／47）患者间断有左心衰竭症状。51例行单纯超滤患者中，2例因血小板进行性减少而中止单纯超滤。1例因收缩压低于90mmI-Ig（1mmHg=0．133kpa）且有脏器灌注不足临床表现终止单纯超滤。48例行单纯超滤患者生命体征平稳，心力衰竭症状明显减轻。单纯超滤治疗后血电解质较治疗前显著改善，B型脑利钠肽（BNP）明显降低（P〈0．05），1周后复测左室射血分数LVEF有所改善（P〈0．05），2例死于心源性猝死，其余46例，均在住院20～39d后出院，随访1年，无左心衰竭再次发作。2组患者1个月病死率、平均重症监护时间、平均住院时间差异均具有统计学意义（P〈0．05）。结论急性心肌梗死后心功能不全患者行单纯超滤是一种相对安全而有效的治疗方法。不仅能在较短时间内稳定内环境，而且能干预心肌梗死后左心衰竭的发展和预后，使平均重症监护时间、平均住院时间显著降低。

Objective To evaluate the efficacy of isolated ultrafiltration （IUF） for patients with cardiac insufficiency after acut emyocardial infarction （AMI）. Methods The acut emyocardial infarction patients admitted from August 2010 to August 2014 were recruited for study. After primary percutaneous coronary intervention （PCI） , 102 patients presented cardiac insufficiency taking the form of hypotension and acute left heart failure. All heart failure patients dealt with routine medications at first, and were then randomly （random number） divided into two groups, group A was routine medication group and group B was isolated ultrafiltration after routine medication group. Data recorded at different intervals in the same group were analyzed by ANOVA. Data recorded from two groups at the same intervals were analyzed by t test. Data of mortality in the two groups were analyzed by X2 test. P value less than 0. 05 was considered statistically significant. Results Of them, 51 patients were treated with routine medication resulting in gradual improvement of cardiac function, but the improvement was slower compared with the isolated ultrafihration group. Other 51 patients were treated with isolated ultrafiltration, and isolated uftrafihration was discontinued in 2 patients owing to progressive thrombocytopenia and in another one patient owing to systolic blood pressure below 90 mmHg, with clinical manifestations of organ hypoperfusion, poor peripheral circulation, cool clammy skin and oliguria. In the rest of 48 patients in the isolated ultrafihration group, vital signs were stable, and heart failure symptoms and serum electrolytes improved significantly （P 〈 0.05 ） . After one week of using isolated ultrafiltration, left ventrieular ejection fraction （ LVEF ） also improved （P 〈 0. 05 ）. The differences in mortality within one month, the mean ICU stay, the mean hospitalized stay, and the rate of recurrent heart failure were significant between the two groups （ P 〈 0. 05 ） . Conclusions The isolated ultrafiltration is a relatively safe and effective strategy for patients with cardiac insufficiency and hypotension after acut emyocardial infarction.