超滤脱水装置在顽固性心衰患者中的应用
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摘要
目的:研究探讨超滤脱水装置在顽固性心衰患者治疗中的应用效果。方法:选取我院近3年收治的顽固性心衰患者70例为研究对象,采用超滤脱水装置进行超滤治疗。持续治疗4周以后,对患者的临床疗效进行观察评价,并对患者的治疗前后的基础生理指标包括患者的心率、体重、平均动脉压进行检测比较,以及患者的心功能、肾功能指标的改善情况。结果:(1)本研究中超滤法治疗顽固性心衰患者的临床总有效率为97.14%(68/70),临床疗效显著。(2)治疗后患者的心率、体重、医学研究会呼吸困难量表(medical research council scale,MRC)分别为(94.12±10.21)次/min、(65.97±6.89)Kg、(2.47±1.02)分,显著低于治疗前为(110.67±11.83)次/min、(71.73±7.93)Kg、(3.56±1.21)分,差异有统计学意义(P<0.05)。治疗前后患者的平均动脉压(mean arterial pressure,MAP)无显著变化。(3)治疗后患者的心功能指标包括心输出量、左室射血分数(Left ventricular ejection fraction,LVEF)、B型脑钠肽(brain natriuretic peptide,BNP)分别为(5.09±1.14)L/min、(48.92±8.31)%、(1486.34±197.95)pg/mL,显著优于治疗前分别为(2.32±1.01)L/min、(29.76±7.09)%、(3979.35±646.42)pg/mL,差异有统计学意义(P<0.05)。(4)患者治疗前后的肾功能指标包括肾小球滤过率(glomerular filtration rate,GFR)、肌酐(creatinine,Cr)、尿素氮(Blood urea nitrogen,BUN)等水平值无统计学差异,提示超滤前后不影响患者的肾功能。结论:应用超滤脱水装置对顽固性心衰患者进行超滤治疗的临床疗效显著,能够迅速缓解患者的症状,改善患者心功能,且操作简便,有较高的临床应用价值。
Objective: To study the effect of ultrafiltration dehydration device in the treatment of refractory heart failure patients.Methods: 70 patients with refractory heart failure treated in our hospital in recent 3 years were selected as the research objects, and ultrafiltration dehydration device was used for ultrafiltration treatment. 4 weeks later, observe and evaluate the clinical curative effects of the patients, and the physiological indexes of patients before and after treatment were compared in patients including heart rate, body weight, mean arterial pressure, and improve the renal function index of patients with cardiac function. Results:(1) the total effective rate of ultrafiltration in the treatment of refractory heart failure patients was 97.14%(68/70), and the clinical efficacy was remarkable.(2) after the treatment of patients with heart rate, body weight, Medical Association Dyspnea Scale(Medical Research Council scale, MRC)respectively(94.12 + 10.21)/min,(65.97 + 6.89)Kg,(2.47 + 1.02)min, was significantly lower than that before treatment(110.67 +11.83)/min,(71.73 + 7.93)Kg,(3.56 + 1.21)min, the difference was statistically significant(P<0.05). The mean arterial pressure(mean,arterial, pressure, MAP) did not change significantly before and after treatment.(3) heart function indexes of patients after treatment,including cardiac output, left ventricular ejection fraction(Left ventricular ejection fraction, LVEF), B-type natriuretic peptide(brain natriuretic, peptide, BNP) respectively(5.09 + 1.14)L/min,(48.92 + 8.31)% and(1486.34 + 197.95) pg/mL. Significantly better than before treatment respectively(2.32 + 1.01)L/min,(29.76 + 7.09)% and(3979.35 + 646.42) pg/mL, the difference was statistically significant(P<0.05).(4) renal function indexes before and after treatment in patients with glomerular filtration rate(including glomerular filtration rate, GFR), creatinine(creatinine, Cr), blood urea nitrogen(Blood urea, nitrogen, BUN) there was no significant difference in the level of value, that does not affect the renal function of the patients before and after ultrafiltration can. Conclusion: The application of ultrafiltration device in patients with refractory heart failure clinical curative effect of ultrafiltration treatment significantly, can quickly relieve symptoms, improve heart function, and the operation is simple, has high value in clinical application.
Objective: To study the effect of ultrafiltration dehydration device in the treatment of refractory heart failure patients.Methods: 70 patients with refractory heart failure treated in our hospital in recent 3 years were selected as the research objects, and ultrafiltration dehydration device was used for ultrafiltration treatment. 4 weeks later, observe and evaluate the clinical curative effects of the patients, and the physiological indexes of patients before and after treatment were compared in patients including heart rate, body weight, mean arterial pressure, and improve the renal function index of patients with cardiac function. Results:(1) the total effective rate of ultrafiltration in the treatment of refractory heart failure patients was 97.14%(68/70), and the clinical efficacy was remarkable.(2) after the treatment of patients with heart rate, body weight, Medical Association Dyspnea Scale(Medical Research Council scale, MRC)respectively(94.12 + 10.21)/min,(65.97 + 6.89)Kg,(2.47 + 1.02)min, was significantly lower than that before treatment(110.67 +11.83)/min,(71.73 + 7.93)Kg,(3.56 + 1.21)min, the difference was statistically significant(P<0.05). The mean arterial pressure(mean,arterial, pressure, MAP) did not change significantly before and after treatment.(3) heart function indexes of patients after treatment,including cardiac output, left ventricular ejection fraction(Left ventricular ejection fraction, LVEF), B-type natriuretic peptide(brain natriuretic, peptide, BNP) respectively(5.09 + 1.14)L/min,(48.92 + 8.31)% and(1486.34 + 197.95) pg/mL. Significantly better than before treatment respectively(2.32 + 1.01)L/min,(29.76 + 7.09)% and(3979.35 + 646.42) pg/mL, the difference was statistically significant(P<0.05).(4) renal function indexes before and after treatment in patients with glomerular filtration rate(including glomerular filtration rate, GFR), creatinine(creatinine, Cr), blood urea nitrogen(Blood urea, nitrogen, BUN) there was no significant difference in the level of value, that does not affect the renal function of the patients before and after ultrafiltration can. Conclusion: The application of ultrafiltration device in patients with refractory heart failure clinical curative effect of ultrafiltration treatment significantly, can quickly relieve symptoms, improve heart function, and the operation is simple, has high value in clinical application.
引文
[1]孙玉玺,陈维,徐亚伟,等.心力衰竭超滤脱水技术临床应用研究进展[J].中国实用内科杂志,2016,36(7):603-607Sun Yu-xi,Chen Wei,Xu Ya-wei,et al.Progress in clinical application of ultrafiltration technology for congestive heart failure[J].Chinese Journal of practical internal medicine,2016,36(7):603-607
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[4]Marenzi G,Morpurgo M,Agostoni P.Continuous Ultrafiltration in Acute Decompensated Heart Failure:Current Issues and Future Directions[J].American Journal of Cardiovascular Drugs Drugs Devices&Other Interventions,2015,15(2):103-112
[5]姜利.持续床旁血滤治疗顽固性心力衰竭疗效评估[D].泰山医学院,2015Jiang Li.Effect evaluation of continuous bedside hemofiltration in the treatment of refractory heart failure[D].Taishan Medical University,2015
[6]李旭,刘加明,李玉琴,等.连续性血液透析滤过改善顽固性心力衰竭患者心功能的机制探讨[J].中国血液净化,2015,14(11):662-666Li Xu,Liu Jia-ming,Li Yu-qin,et al.Mechanism of continuous hemodialysis filtration for improving cardiac function in patients with intractable heart failure[J].China blood purification,2015,14(11):662-666
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[8]王洪瑞,闫明宇.普通血液透析治疗慢性肾功能不全并心功能不全患者疗效观察[J].中国冶金工业医学杂志,2015,32(2):158-159Wang Hong-rui,Yan Ming-yu.Regular hemodialysis in the treatment of chronic renal insufficiency and heart failure in patients with clinical observation[J].Chinese metallurgical industry medical journal,2015,32(2):158-159
[9]Goumenos D S,Papachristou E,Papasotiriou M.Renal Replacement Therapy in Patients with Heart and Kidney Failure[J].Prilozi(Makedonska akademija na naukite i umetnostite.Oddelenie za medicinski nauki),2016,37(2):43-47
[10]金艳盛,丁岚,孔明明.单纯超滤治疗顽固性心力衰竭2例[J].中西医结合心脑血管病杂志,2015,13(11):1343-1344Jin Yan-sheng,Ding Lan,Kong Ming-ming.Ultrafiltration alone in the treatment of 2 cases of refractory heart failure[J].Journal of cardiovascular and pulmonary diseases,2015,13(11):1343-1344
[11]徐海燕,熊敏,袁占占.血液超滤联合持续泵入呋塞米对利尿剂抵抗的顽固性心力衰竭患者心功能及炎性因子的影响[J].河北医药,2017,39(9):1395-1397Xu Hai-yan,Xiong Min,Yuan Zhan-zhan.Ultrafiltration combined with continuous infusion of furosemide on diuretic resistance in patients with refractory heart failure cardiac function and inflammatory factors[J].Hebei medicine,2017,39(9):1395-1397
[12]黎晓磊,孔耀中,肖观清,等.应用生物电阻抗法评估血液透析患者残余肾功能[J].实用医学杂志,2015,26(5):770-774Li Xiao-lei,Kong Yao-zhong,Xiao Guan-qing,et al.Evaluation of residual renal function in hemodialysis patients by bioelectrical impedance spectroscopy[J].Journal of practical medicine,2015,25(5):770-774
[13]Radzishevsky E,Salman N,Paz H,et al.First experience in ambulatory ultrafiltration therapy for congested heart failure patients in Israel:a feasibility study[J].Israel Medical Association Journal Imaj,2015,17(1):24-26
[14]Lu R,Muci?obermejo M,Ribeiro L C,et al.Peritoneal Dialysis in Patients with Refractory Congestive Heart Failure:A Systematic Review[J].Cardiorenal Medicine,2015,5(2):145-149
[15]李文宏,王晋文,陈浩,等.高频超滤对抗利尿性肾性水肿的疗效评价[J].临床肾脏病杂志,2015,15(2):98-101Li Wen-hong,Wang Jin-wen,Chen Hao,et al.Evaluation of high frequency ultrafiltration in the treatment of diuretic renal edema[J].Journal of clinical nephrology,2015,15(2):98-101
[16]Wehbe E,Patarroyo M,Taliercio J J,et al.Renal failure requiring dialysis complicating slow continuous ultrafiltration in acute heart failure:importance of systolic perfusion pressure[J].Journal of Cardiac Failure,2015,21(2):108-115
[17]Quirós-Ganga P L,Remón-Rodríguez C,Tejuca-Marenco M,et al.Peritoneal dialysis allows successful cardiac transplantation in patients with refractory heart failure[J].Nefrologia,2015,35(1):121-124
[18]王静,鄢艳,闵宝妹.缓慢连续性超滤治疗30例重度浮肿患者的观察及心理干预[J].中国保健营养,2016,26(3):387-388Wang Jing,Yan Yan,Min Bao-mei.Slow continuous ultrafiltration treatment of 30 cases of severe edema were observed and the psychological intervention[J].Chinese health nutrition,2016,26(3):387-388
[19]Gin S,Jollivet P,Fournier M,et al.The fate of silicon during glass corrosion under alkaline conditions:A mechanistic and kinetic study with the International Simple Glass[J].Geochimica Et Cosmochimica Acta,2015,151(5):68-85
[20]姚建东.血液透析超滤加传统药物治疗顽固性心力衰竭36例体会[J].武警后勤学院学报(医学版),2012,21(7):555-556Yao Jian-dong.Hemodialysis,ultrafiltration and traditional drugs in the treatment of 36 cases of refractory heart failure[J].Journal of Military Logistics College(Medical Edition),2012,21(7):555-556
[21]Nongnuch A,Assanatham M,Panorchan K,et al.Strategies for preserving residual renal function in peritoneal dialysis patients[J].Clinical Kidney Journal,2015,8(2):202-209
[22]Schutyser M A I,Pelgrom P J M,Goot A J V D,et al.Dry fractionation for sustainable production of functional legume protein concentrates[J].Trends in Food Science&Technology,2015,45(2):327-335
[2]刘国庆.血液透析在急、慢性心衰治疗领域中的尝试[J].中国现代药物应用,2015,9(11):110-111Liu Guo-qing.The application of hemodialysis in the treatment of acute and chronic heart failure[J].Chinese Journal of modern drug application,2015,9(11):110-111
[3]祖丽比娅·艾萨,帕尔哈提·吐尔逊,姜述斌.超滤在难治性心力衰竭中的应用[J].实用中西医结合临床,2015,15(6):40-41Zulibya Esa,Perhat Tuerxun,Jiang Shu-bin.Application of ultrafiltration in the treatment of refractory heart failure[J].Chinese medicine with traditional Chinese medicine and Western medicine,2015,15(6):40-41
[4]Marenzi G,Morpurgo M,Agostoni P.Continuous Ultrafiltration in Acute Decompensated Heart Failure:Current Issues and Future Directions[J].American Journal of Cardiovascular Drugs Drugs Devices&Other Interventions,2015,15(2):103-112
[5]姜利.持续床旁血滤治疗顽固性心力衰竭疗效评估[D].泰山医学院,2015Jiang Li.Effect evaluation of continuous bedside hemofiltration in the treatment of refractory heart failure[D].Taishan Medical University,2015
[6]李旭,刘加明,李玉琴,等.连续性血液透析滤过改善顽固性心力衰竭患者心功能的机制探讨[J].中国血液净化,2015,14(11):662-666Li Xu,Liu Jia-ming,Li Yu-qin,et al.Mechanism of continuous hemodialysis filtration for improving cardiac function in patients with intractable heart failure[J].China blood purification,2015,14(11):662-666
[7]潘娟.超滤治疗对慢性心力衰竭急性发作患者心肾功能的影响[D].湖南师范大学,2016Pan Juan.Influence of ultrafiltration on cardiac and renal function in patients with acute attack of chronic heart failure[D].Hunan Normal University,2016
[8]王洪瑞,闫明宇.普通血液透析治疗慢性肾功能不全并心功能不全患者疗效观察[J].中国冶金工业医学杂志,2015,32(2):158-159Wang Hong-rui,Yan Ming-yu.Regular hemodialysis in the treatment of chronic renal insufficiency and heart failure in patients with clinical observation[J].Chinese metallurgical industry medical journal,2015,32(2):158-159
[9]Goumenos D S,Papachristou E,Papasotiriou M.Renal Replacement Therapy in Patients with Heart and Kidney Failure[J].Prilozi(Makedonska akademija na naukite i umetnostite.Oddelenie za medicinski nauki),2016,37(2):43-47
[10]金艳盛,丁岚,孔明明.单纯超滤治疗顽固性心力衰竭2例[J].中西医结合心脑血管病杂志,2015,13(11):1343-1344Jin Yan-sheng,Ding Lan,Kong Ming-ming.Ultrafiltration alone in the treatment of 2 cases of refractory heart failure[J].Journal of cardiovascular and pulmonary diseases,2015,13(11):1343-1344
[11]徐海燕,熊敏,袁占占.血液超滤联合持续泵入呋塞米对利尿剂抵抗的顽固性心力衰竭患者心功能及炎性因子的影响[J].河北医药,2017,39(9):1395-1397Xu Hai-yan,Xiong Min,Yuan Zhan-zhan.Ultrafiltration combined with continuous infusion of furosemide on diuretic resistance in patients with refractory heart failure cardiac function and inflammatory factors[J].Hebei medicine,2017,39(9):1395-1397
[12]黎晓磊,孔耀中,肖观清,等.应用生物电阻抗法评估血液透析患者残余肾功能[J].实用医学杂志,2015,26(5):770-774Li Xiao-lei,Kong Yao-zhong,Xiao Guan-qing,et al.Evaluation of residual renal function in hemodialysis patients by bioelectrical impedance spectroscopy[J].Journal of practical medicine,2015,25(5):770-774
[13]Radzishevsky E,Salman N,Paz H,et al.First experience in ambulatory ultrafiltration therapy for congested heart failure patients in Israel:a feasibility study[J].Israel Medical Association Journal Imaj,2015,17(1):24-26
[14]Lu R,Muci?obermejo M,Ribeiro L C,et al.Peritoneal Dialysis in Patients with Refractory Congestive Heart Failure:A Systematic Review[J].Cardiorenal Medicine,2015,5(2):145-149
[15]李文宏,王晋文,陈浩,等.高频超滤对抗利尿性肾性水肿的疗效评价[J].临床肾脏病杂志,2015,15(2):98-101Li Wen-hong,Wang Jin-wen,Chen Hao,et al.Evaluation of high frequency ultrafiltration in the treatment of diuretic renal edema[J].Journal of clinical nephrology,2015,15(2):98-101
[16]Wehbe E,Patarroyo M,Taliercio J J,et al.Renal failure requiring dialysis complicating slow continuous ultrafiltration in acute heart failure:importance of systolic perfusion pressure[J].Journal of Cardiac Failure,2015,21(2):108-115
[17]Quirós-Ganga P L,Remón-Rodríguez C,Tejuca-Marenco M,et al.Peritoneal dialysis allows successful cardiac transplantation in patients with refractory heart failure[J].Nefrologia,2015,35(1):121-124
[18]王静,鄢艳,闵宝妹.缓慢连续性超滤治疗30例重度浮肿患者的观察及心理干预[J].中国保健营养,2016,26(3):387-388Wang Jing,Yan Yan,Min Bao-mei.Slow continuous ultrafiltration treatment of 30 cases of severe edema were observed and the psychological intervention[J].Chinese health nutrition,2016,26(3):387-388
[19]Gin S,Jollivet P,Fournier M,et al.The fate of silicon during glass corrosion under alkaline conditions:A mechanistic and kinetic study with the International Simple Glass[J].Geochimica Et Cosmochimica Acta,2015,151(5):68-85
[20]姚建东.血液透析超滤加传统药物治疗顽固性心力衰竭36例体会[J].武警后勤学院学报(医学版),2012,21(7):555-556Yao Jian-dong.Hemodialysis,ultrafiltration and traditional drugs in the treatment of 36 cases of refractory heart failure[J].Journal of Military Logistics College(Medical Edition),2012,21(7):555-556
[21]Nongnuch A,Assanatham M,Panorchan K,et al.Strategies for preserving residual renal function in peritoneal dialysis patients[J].Clinical Kidney Journal,2015,8(2):202-209
[22]Schutyser M A I,Pelgrom P J M,Goot A J V D,et al.Dry fractionation for sustainable production of functional legume protein concentrates[J].Trends in Food Science&Technology,2015,45(2):327-335