血液超滤治疗在急性失代偿心衰容量管理中的应用

Application of blood ultra-filtration in the management of acute decompensated heart failure

目的:探讨血液超滤治疗在急性失代偿心衰容量管理中的应用效果。方法:选取2015年10月至2016年12月医院CCU收治的急性失代偿心衰患者56例,随机分为强化利尿治疗(强化利尿组)32例、连续性静脉血液滤过(血滤治疗组)24例。强化利尿组接受常规治疗无改善后立即采用床旁血液超滤治疗。结果:强化利尿组32例中显效8例(25.0%)、有效19例(58.4%)、无效5例(15.6%);血滤治疗组24例中显效19例(79.2%)、有效5例(20.8%)。强化利尿组无效5例中改行血滤治疗后有效4例(80.0%),死亡1例;血滤治疗组患者短期疗效好于强化利尿组患者(P<0.05);症状缓解后强化利尿组左心室收缩末期内径、左心室舒张末期内径均大于血滤治疗组(P<0.05),而射血分数小于血滤治疗组(P<0.05);症状缓解后,两组患者动脉血p H值、氧分压、二氧化碳分压、碳酸氢盐及血氧氧饱和度比较,差异均无统计学意义(P>0.05)。结论:血液超滤治疗在急性失代偿左心衰患者容量管理中疗效确切,而对于药物治疗无效心衰患者,应尽早行血液滤过治疗。

Objective： To evaluate the effect of blood ultra-filtration therapy on the capacity management of acute decompensated heart failure. Methods： 56 cases of patients with acute decompensated heart failure from October 2015 to December 2016 were randomly divided into two groups： intensive diuretic therapy（ intensive diuretic group,32 cases） and continuous venous filtration（ filtration group,24 cases）. The intensive diuretic group adopted immediate bedside blood ultra-filtration therapy without improvement with routine treatment. Results： In the intensive diuretic group,32 cases were excellent（ 25. 0 %）,19 cases were effective（ 58.4 %） and 5 cases were ineffective（ 15. 6 %）; in the 5 ineffective cases,4 cases were effective（ 80. 0 %） after changing into hemofiltration therapy and 1 case died.In the filtration group,19 cases were excellent（ 79. 2 %） and 5 cases were effective（ 20. 8 %）. The short-term efficacy in the filtration group was significantly better than that in the intensive diuretic group,and there was significant difference of the total effective rate in the two groups（ P〈0. 05）. After the symptom relief,the diastolic diameter of the left ventricle and the left ventricular end diastolic diameter were significantly higher than those in the filtration group（ P〈0. 05）,and the ejection fraction was less than that in the filtration group（ P〈0. 05）. After the symptom relief,the PH value,oxygen partial pressure,partial pressure of carbon dioxide,bicarbonate and oxygen had no statistically significant difference between the two groups（ P〉0. 05）. Conclusion： Blood ultra-filtration therapy is effective in the management of patients with acute decompensated left heart failure,and the blood therapy should be performed as soon as possible for heart failure patients ineffective with drug treatment.