超滤治疗在急性心力衰竭患者中的应用进展

Advances in the application of ultra-filtration in patients with acute heart failure

容量超负荷是急性心力衰竭(心衰)患者住院的主要原因,也是其不良预后的重要预测因素,因而减容是急性心衰治疗的首要目标。体外超滤治疗作为一种有前景的机械性脱水措施,较静脉利尿剂能更加有效地清除液体潴留,改善心衰症状,减少心衰再住院。目前相关指南或共识推荐超滤治疗用于伴有容量超负荷的急性心衰患者,作为利尿剂治疗无效或利尿剂抵抗的二线治疗。心衰专用的新型超滤设备的出现,促进了超滤治疗在急性心衰患者中的应用。本文将从以下几个方面介绍超滤治疗在急性心衰患者中的应用进展:急性心衰的定义、分类和流行病学特点,心衰相关的容量超负荷产生的原因、机制及临床意义,利尿剂在减容治疗中的价值及不足,超滤治疗的原理及超滤设备的发展,心衰专用的新型超滤装置的特点,超滤治疗与利尿剂治疗清除液体潴留的区别,评价超滤治疗有效性和安全性的临床研究,超滤治疗的卫生经济学评价,超滤治疗的临床应用,总结及展望等。

Fluid overload is the predominant cause of hospitalization with acute heart failure(AHF)and an important predictor of adverse outcome.Volume reduction is therefore considered as priority for patients with AHF.As one promising therapeutic choice,extracorporeal ultra-filtration can produce greater fluid removal and weight loss accompanied by significant improvement in symptoms of AHF and reduction in re-hospitalization.According to updated guidelines of HF,ultra-filtration may be considered for patients with AHF and volume overload who failed to respond to diuretic-based strategies or with diuretic resistance as a second-line therapy.Novel ultra-filtration device specific for HF has promoted the research and application of ultra-filtration in patients with AHF.This review will introduce the advances in the application of ultra-filtration in patients with AHF from the following aspects,the definition,classification and epidemiological features of AHF,the causes,mechanism and clinical significance of fluid overload related to HF,the value and limitations of diuretics in volume reduction,working principle and development of ultra-filtration device,characteristics of novel isolated ultra-filtration device specific for HF,differences in fluid removal with ultra-filtration versus diuretics,clinical trials on the efficacy and safety of ultra-filtration in patients with AHF,health economics evaluation of ultra-filtration,the clinical application of ultra-filtration,summary and perspectives,etc.