【摘要】目的 探讨应用连续性血液净化(CBP)治疗重症心力衰竭合并肾功能衰竭的价值。方法 对我院危重病科2OO3年6月～2OO7年9月应用CBP治疗的19例重症心力衰竭合并肾功能衰竭患者资料进行回顾性分析。观察患者治疗前后血生化、动脉血气分析、血压、呼吸频率、心率、氧合指数和左室射血分数的改变。治疗前后记录Boston心衰积分、APACHEII评分。结果 14例患者心功能明显改善, 有效率73.7%；CBP治疗后患者血肌酐、血尿素氮很快下降，内环境能维持在相对稳定的水平；氧合功能逐渐改善，Boston心衰积分和APACHEII评分明显降低；治疗过程生命征稳定，低血压和心律失常发生率低。结论 CBP能平稳地清除水分和溶质并保持血流动力学的稳定,可以安全有效地应用于重症心力衰竭合并肾功能衰竭的治疗。
【Abstract】 Objective To investigate the therapeutic value of continuous blood purification (CBP) in the treatment of severe heart failure patients with renal failure. Methods We retrospectively analyzed 19 cases of severe heart failure complicated with renal failure and treated in our intensive care unit during the period of June, 2003 through Sept., 2007. Blood pressure, heart rate, respiration rate, blood biochemistry, arterial blood gas, oxygenic index (PaO2/FiO2) and left ventricle ejection fraction (LVEF) were monitored before and during the treatment. Score of Boston criteria for diagnosing heart failure and APACHE II score were recorded. Results After CBP, heart function were significantly improved in 14 patients with an effective rate of 73.7%. Serum creatinine and blood urea nitrogen decreased quickly, and homeostasis was re-established. The oxygenic index improved gradually, and the score of Boston criteria for diagnosing heart failure and APACHE II score decreased significantly after the treatment. Their vital signs stabilized, and hypotension and arrhythmia were rarely encountered during CBP. Conclusions CBP maintains a stable hemodynamics situation during cleaning excess water and solute. Therefore, CBP is an effective and safe method for the treatment of severe heart failure with renal failure.
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