连续性血液净化治疗顽固性心力衰竭和清除炎症介质临床研究  

Clinical investigation of continuous veno-venous hemofiltration on refractory heart failure and clearance of inflammatory mediators

作　　者：黄洁平[1] 邓行江[1] 何建发[1] 李莉[1] 何敏[1] 张魁正[1] 李洁珍[1] 

机构地区：[1]广东省韶关粤北人民医院肾内科,韶关512026

出　　处：《中国血液净化》2011年第4期201-203,共3页Chinese Journal of Blood Purification

摘　　要：目的探讨应用持续静静脉血液滤过(continuous veno-venous hemofiltration,CVVH)技术对顽固性心力衰竭患者炎症介质水平的影响。方法 19例顽固性心力衰竭患者经右侧股静脉插管留置单针单腔导管,行CVVH模式治疗。于CVVH治疗前后,检测血液电解质和肾功能,于CVVH治疗前和治疗后1、2、4、6、8h抽取静脉血液检测炎症介质,其中采用酶联免疫吸附法测定有关炎症介质因子。观察心功能指标和临床转归。结果19例患者CVVH后血尿素氮、血清肌酐和K+均下降(P<0.05);肿瘤坏死因子á、白细胞介素6和白细胞介素8水平降低(P<0.05);左心室射血分数、心输出量和心脏指数均明显提高(P<0.05);治疗后纽约心脏病学会心功能分级为Ⅰ级2例,Ⅱ级13例,Ⅲ级4例;显效15例(78.8%),有效4例(21.2%),除个别患者出现轻微头晕、恶心等,均无严重并发症出现。结论 CVVH能清除顽固性心力衰竭患者血浆多种炎症介质因子,并可降低血尿素氮、血清肌酐和K+水平,改善心功能和预后。Objective To investigate the effects of continuous veno-venous hemofiltration（CVVH） on the levels of inflammatory mediators in patients with refractory heart failure.Methods Nineteen patients fulfilled the criteria of refractory heart failure were recruited in this study.A single lumen catheter was indwelled into the right femoral vein,and CVVH was performed.Blood biochemical markers including electrolytes,urea nitrogen（BUN）,creatinine（Cr） and plasma inflammatory mediators were measured at 0,1,2,4,6 and 8h following CVVH.Plasma inflammatory mediators were measured by ELISA.Results BUN,Cr and serum K＋ levels decreased significantly following CVVH（P〈0.05）.Plasma tumor necrosis factor-αTNF-α,（IL-6） and（IL-8） decreased gradually.Left ventricular ejection fraction（LVEF） and cardiac index（CI） were also evaluated.Conclusion CVVH removes many inflammatory mediators in blood,and lowers the elevated blood biochemical markers including BUN,Cr and serum K＋ in patients with refractory heart failure.CVVH is effective to refractory heart failure and its complications,such as severe edema,electrolyte disturbances and acid base imbalances.

关 键 词：持续静静脉血液滤过 顽固性心力衰竭 炎症介质 

分 类 号：R459.5[医药卫生—治疗学]