连续性静脉-静脉血液滤过对心肾综合征临床疗效观察.doc

连续性静脉-静脉血液滤过对心肾综合征临床疗效观察[摘要] 目的：探讨连续性静脉-静脉血液滤过（continuous venovenous hemofiltration，CVVH）对心肾综合征患者的顽固性心衰及渐进性肾衰的缓解作用。方法：采用CVVH的方法治疗心肾综合征患者16例（血滤组），观察其治疗前后心功能及各项临床指标的变化，并与单纯应用药物治疗心肾综合征患者（对照组）作对比。结果：血滤组患者治疗后心功能及临床不适症状等均明显改善，而对照组则变化不明显，甚至加重。结论：CVVH能够显著改善心肾综合征患者的心、肾功能，且疗效确切，无明显副作用。 [关键词] 心肾综合征；连续性静脉-静脉血液滤过；心力衰竭 [中图分类号] R692.5；R459.5[文献标识码]A [文章编号]1674-4721（2010）10（c）-017－０3 The observation of effect of CVVH in treating cardiorenal syndrome ZHAO Yuhong, TAN Yanjie (Department of Nephrology, Fengtian Hospital Affiliated to Shenyang Medical College, Shenyang 110024, China) [Abstract] Objective: To investigate the relieving effect of continuous venovenous hemofiltration (CVVH) on the refractory heart failure and progressive renal failure of cardiorenal syndrome patients. Methods: 16 cardiorenal syndrome patients would be scheduled for the treatment of CVVH (hemofiltration group), and observed the changes of heart function and various clinical indexes after the treatment. Then compared with those cardiorenal syndrome patients (control group) who acceptted the treatment of simple drugs therapy. Results: The heart function and clinical discomfort symptoms of hemofiltration group were obviously improved, but those of control group had no obvious change and even became more severe. Conclusion: CVVH can remarkably improve the heart, renal function, and the effect is exact without side effect. [Key words] Cardiorenal syndrome; Continuous venovenous hemofiltration; Heart failure 众所周知，血液净化疗法是治疗终末期肾衰竭的常用肾脏替代疗法，对于原发于肾脏的肾衰竭是仅次于肾移植的较好的治疗办法[1]，而对于继发性肾衰竭却是无可替代的提高生活质量、维持良好生命状态的首选治疗办法[2]。这其中连续性肾脏替代治疗（CRRT）疗法比普通血液透析在抢救及治疗各种内外科急症导致的急慢性肾衰竭、多脏器衰竭和重症感染等的治疗中具有起效快、疗效好和风险性小等优点[3]，根据血液通路不同CRRT可分为连续性静脉-静脉血液滤过（CVVH）及连续性动脉-静脉血液滤过（CAVH）等。在临床急危重症中难治性心衰逐渐引起人们的注意，由于综合药物治疗无效，且常引起肾衰竭，而后者通常又使得前者进一步加重，即“心肾综合征（cardiorenal syndrome）”[4]，于是就需要血液净化治疗来缓解上述危急情况。我院近几年应用CVVH治疗心肾综合征取得了很好的成效，现将体会总结如下： 1 对象与方法 1.1 对象 我院2007年3月～2010年3月间符合心肾综合征诊断标准的患者34例，分别为我院心内科、肾内科及ICU病房的住院患者，18例应用常规综合药物治疗作