持续性血液滤过联合有创机械通气治疗难治性心衰患者24例疗效观察

Clinical Efficacy of Continuous Vena-venous Hemofiltration Combined with Invasive Mechanical Ventilation on Refractory Heart Failure （24 Cases of Report）

【目的】探讨持续性血液滤过联合有创机械通气治疗难治性心力衰竭（心衰）的临床效果。【方法】选取2015年3月至2017年4月株洲市中心医院ICU收治的进行有创机械通气治疗的46例难治性心衰患者，将其随机分为对照组（n=22）和观察组（n=24），对照组给予常规治疗及有创机械通气治疗，观察组则在对照组治疗基础上联合持续性血液滤过（CVVH）治疗。比较两组治疗前后心功能、肾功能及相关呼吸功能指标改善情况。【结果】治疗后，观察组左室射血分数、心输出量、氧合指数改善程度均明显优于对照组，血尿素氮及肌酐水平均低于对照组，差异具有统计学意义（P〈0．05）；观察组肺部超声B线数目减少程度优于对照组，有创机械通气时间短于对照组，差异具有统计学意义（P〈0．05）。【结论】对于难治性心衰需行有创机械通气患者联合持续性血液滤过治疗，可较好的改善患者心肾功能、提早撤机，临床推广应用价值高。

[Objective]To explore the clinical effect of continuous Vena-venous hemofiltration（CVVH） com- bined with invasive mechanical ventilation for refractory heart failure. [Methods] A total of 46 patients with re- fractory heart failure were selected in the ICU of the Zhuzhou Center Hospital from March 2015to April 2017, and they were divided into observation group （ n = 24） and control group （ n = 22 ） by using the random number ta- ble method. The control group was treated with routine therapy and invasive mechanical ventilation, while the ob- servation group was treated with continuous hemofiltration CVVH on the basis of the control group. The improve- ment of cardiac function, renal function and related respiratory function was compared between the two groups be- fore and after treatment.[Results]After treatment, the improvement of left ventricular ejection fraction, cardiac output and oxygenation index in the observation group was significantly better than that in the control group, and the levels of blood urea nitrogen and creatinine in the observation group were lower than those in the control group （ P 〈0.05）. Compared with the control group, the number of B-line ultrasound in the observation group was sig- nificantly lower than that in the control group （ P 〈0.05）, and the time of invasive mechanical ventilation was shorter than that in the control group, the difference was statistically significant （ P〈0.05）.[Conclusion]For re- fractory heart failure, invasive mechanical ventilation combined with continuous hemofiltration therapy can im- prove the heart and kidney function of patients, remove the machine early, and have high clinical application value.