浅低温CRRT在心血管外科术后心力衰竭患者中的应用  

Application of mild hypothermia combining CRRT in treatment of heart failure after cardiovascular surgery

作　　者：焦若男[1] 张海涛[1] 常谦[1] 杨戎[1] 曹芳芳[1] 

机构地区：[1]北京阜外医院血管外科中心,北京100037

出　　处：《中国循证心血管医学杂志》2013年第3期266-269,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的观察浅低温持续肾脏替代治疗(continuous renal replacement therapy,CRRT)对心血管外科术后严重心衰的应用效果及安全性。方法纳入2007年～2010年北京阜外医院心血管外科术后严重心力衰及患者中的患者8例;应用CRRT减低心脏负荷,控制中心血温34℃;至肺动脉楔压12mmHg,平均动脉压>70mmHg、心排血量>4.0L/min后恢复中心血温36.5℃,撤除CRRT,对比血滤前后心输出量、平均动脉压、肺动脉楔压等血流动力学改变,并评估肝、肾等各脏器功能。结果浅低温CRRT治疗后叫治疗前,中心静脉压下降[(16.2±4.5)mmHgvs.(8.7±1.7)mmHg,P<0.05),心输出量有上升趋势[(3.9±0.7)L/minvs.(4.5±1.1)L/min,P>0.05),肺动脉楔压有下降趋势[(15.5±4.1)mmHgvs.(12.1±0.6)mmHg,P>0.05)。1例死于严重代谢紊乱,7例出院。结论浅低温联合CRRT治疗心血管外科术后严重心衰患者,可减轻其心脏前负荷,减少心脏做功,降低机体代谢率,改善心功能。Objective To observe the application effectiveness and safety of mild hypothermia combining continuous renal replacement therapy （CRRT） in treatment of heart failure after cardiovascular surgery. Methods The patients with heart failure after cardiovascular surgery （n=8） were chosen from Beijing Fuwai Hospital from 2007 to 2010. CRRT was used to reduce cardiac loading and keep central blood temperature at 34℃, and removed until pulmonary artery wedge pressure to 12 mmHg, mean arterial pressure over 70 mmHg, cardiac output over 4.0 L/min and central blood temperature to 36.5 ℃. The changes of hemodynamics were compared and functions of liver and kidney were reviewed before and after mild hypothermia combining CRRT. Results The comparison before and after mild hypothermia combining CRRT showed that central venous blood pressure decreased [16.2 ± 4.5） mmHg vs. （8.7 ± 1.7 ）mmHg, P〈O.05）, cardiac output had increasing tendency [（3.9 ± 0.7 ）L/rain vs. （4.5 ± 1.1 ）L/min, P〈0.05） and pulmonary artery wedge pressure had decreasing tendency [（15.5 ± 4.1 ）mmHg vs. （12.1 ± 0.6） mmHg, P〈0.05）. There was one ease died of serious metabolism disorder and 7 discharged. Conclusion The treatment of heart failure after cardiovascular surgery with mild hypothermia combining CRRT can reduce heart preloading, cardiac efficiency and body metabolic rate and improve heart function.

关 键 词：浅低温 心力衰竭 持续肾脏替代治疗 

分 类 号：R541.61[医药卫生—心血管疾病]