连续性静脉-静脉血液透析滤过治疗利尿剂抵抗的顽固性心力衰竭疗效观察  

Therapeutic effect of continuous veno-venous hemodiafiltration in the treatment of diuretic-resistant refractory heart failure

作　　者：王斌[1] 高毅滨[1] 徐荣红[1] WANG Bin;GAO Yi-bin;XU Rong-hong(Department of Cardiology,the People′s Hospital of Luzhou City,Luzhou 646000,Sichuan Province,China)

机构地区：[1]泸州市人民医院心血管内科,四川泸州646000

出　　处：《新乡医学院学报》2018年第7期577-580,共4页Journal of Xinxiang Medical University

摘　　要：目的探讨连续性静脉-静脉血液透析滤过(CVVHDF)治疗利尿剂抵抗的顽固性心力衰竭(RHF)患者的临床疗效。方法将2014年5月至2017年5月泸州市人民医院收治的104例利尿剂抵抗的RHF患者分为对照组和观察组,每组52例。对照组患者给予以利尿、扩血管和强心治疗,观察组患者在对照组治疗的基础上给予CVVHDF治疗,2组患者均治疗14周。比较2组患者治疗前后24 h尿量、体质量(BW)、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、心输出量(CO)、每搏输出量(SV)、心脏指数(CI)、血浆脑钠肽(BNP)水平及血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)水平,并评价2组患者的临床疗效。结果 2组患者治疗前24 h尿量、BW、血浆BNP水平、LVEF、LVEDD、CO、SV、CI及血清TNF-α、IL-6、CRP水平比较差异均无统计学意义(P>0.05)。2组患者治疗后24 h尿量、LVEF、CO、SV、CI显著高于治疗前(P<0.05),BW、血浆BNP水平显著低于治疗前(P<0.05)。观察组患者治疗后24 h尿量、LVEF、CO、SV、CI显著高于对照组(P<0.05),BW、血浆BNP水平显著低于对照组(P<0.05)。2组患者治疗后LVEDD与治疗前比较差异无统计学意义(P>0.05);治疗后观察组与对照组患者LVEDD比较差异无统计学意义(P>0.05)。对照组患者治疗后血清TNF-α、IL-6、CRP水平与治疗前比较差异无统计学意义(P>0.05),观察组患者治疗后血清TNF-α、IL-6、CRP水平低于治疗前及对照组(P<0.05)。对照组和观察组患者治疗总有效率分别为69.2%(36/52)和94.2%(49/52),观察组患者治疗总有效率显著高于对照组(χ2=10.881,P<0.01)。结论 CVVHDF能够显著降低利尿剂抵抗的RHF患者血清炎性因子水平,减轻机体的炎性反应,改善患者的心功能。Objective To evaluate the efficacy of continuous veno-venous hemodiafiltration(CVVHDF)on the patients with diuretic-resistant refractory heart failure(RHF).Methods One hundred and one patients with diuretic-resistant RHF in the People′s Hospital of Luzhou City from May 2014 to May 2015 were selected and divided into control and observation group,with 52 patients in each group.The patients in the control group was treatment with diuretic,vasodilator and cardiac treatment,while the patients in the observation group were treated with CVVHDF based on the treatment of the control group.The patients in the two groups were treated for 14 weeks.The 24 h urine volume,body weight(BW),left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),cardiac output(CO),stroke volume(SV),cardiac index(CI),brain natriuretic peptide(BNP),serum tumor necrosis factor alpha(TNF-α),interleukin-6(IL-6)and C reactive protein(CRP)levels were measured before and after treatment.And the clinical efficacy in the two groups was evaluate after treatment.Results There was no significant difference in the 24 h urine volume,BW,LVEF,LVEDD,CO,SV,CI and the levels of BNP,TNF-α,IL-6,CRP between the two groups(P>0.05).Compared with that before treatment,the 24 h urine volume,LVEF,CO,SV,CI were higher,BW and BNP level were lower in the two groups than those after treatment(P<0.05).In the observation group,the 24 h urine volume,LVEF,CO,SV,CI were higher,and BW,BNP level were lower than those in the control group(P<0.05).There was no significant difference in the LVEDD in the two groups before and after treatment(P>0.05),and there was no significant difference in the LVEDD between the two groups after treatment(P>0.05).There was no significant difference in the levels of TNF-α,IL-6,and CRP after treatment compared with that before treatment in the control group(P>0.05).The levels of TNF-α,IL-6,and CRP after treatment in the observation group were lower than that before treatment and the control group(P<0.05).The total effe

关 键 词：顽固性心力衰竭 连续性静脉-静脉血液透析滤过 利尿剂抵抗 心功能 炎性因子 

分 类 号：R541.6[医药卫生—心血管疾病]