ISOLATED ULTRAFILTRATION IN MODERATE CONGESTIVE-HEART-FAILURE
ISOLATED ULTRAFILTRATION IN MODERATE CONGESTIVE-HEART-FAILURE
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DOI：
10.1016/0735-1097(93)90685-t
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发表时间：
1993-02-01
影响因子：
24
通讯作者：
GUAZZI, MD
中科院分区：
文献类型：
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作者：
AGOSTONI, PG;MARENZI, GC;GUAZZI, MD
目标.本研究的目的是评估超滤是否对中度充血性心力衰竭患者有益。超滤对严重充血性心力衰竭患者有益。我们研究了36例纽约心脏协会心功能分级为II级和III级、临床状况稳定的患者。随机选择18例患者（A组），并进行单次超滤（静脉-静脉旁路，平均[+/- SEM]超滤1，880 +/- 174 ml，约600 ml/h），18例（B组）作为对照受试者。A组2例患者和B组3例患者未完成6个月随访研究。在A组中，超滤后不久，右心房压力（从8 +/- 1至3.4 +/- 0.7 mm Hg）、肺楔压（从18 +/- 2.5至10 +/- 1.9 mm Hg）和心脏指数（从2.8 +/- 0.2至2.3 +/- 0.2升/分）显著降低。随访期间，肺功能改善，血管外肺水（X线评分）降低和峰值耗氧量（ml/min/kg）从15.5 +/- 1（第-1天）显著增加至17.6 +/- 0.9（第4天），至17.8 +/- 0.9（第30天），至18.9 +/-1（第90天）和至19.1 +/-1（第180天）。无氧阈值下的耗氧量（ml/min/kg）也从11.6 +/- 0.8（第-1天）显著增加至13 +/- 0.7（第4天）、13.7 +/- 0.5（第30天）、15.5 +/- 0.8（第90天）和15.2 +/- 0.8（第180天）。这些变化与高峰运动时通气量、潮气量和死腔/潮气量比增加有关。运动表现的改善与静息时去甲肾上腺素的减少、次极量运动时去甲肾上腺素动力学的下移和直立倾斜时去甲肾上腺素的增加有关。B组无上述变化。在中度充血性心力衰竭患者中，超滤可降低综合征的严重程度。
Objectives. The aim of this study was to evaluate whether ultrafiltration is beneficial in patients with moderate congestive heart failure.Background. Ultrafiltration is beneficial in patients with severe congestive heart failure.Methods. We studied 36 patients in New York Heart Association functional classes II and III in stable clinical condition. Eighteen patients (group A) were randomly selected and underwent a single session of ultrafiltration (venovenous bypass, mean [+/- SEM] ultrafiltrate 1,880 +/- 174 ml, approximately 600 ml/h) and 18 (group B) served as control subjects.Results. Two patients in group A and three in group B did not complete the 6-month follow-up study. In group A, soon after ultrafiltration there were significant reductions in right atrial pressure (from 8 +/- 1 to 3.4 +/- 0.7 mm Hg, pulmonary wedge pressure (from 18 +/- 2.5 to 10 +/- 1.9 mm Hg) and cardiac index (from 2.8 +/- 0.2 to 2.3 +/- 0.2 liters/min). During the follow-up period, lung function improved, extravascular lung water (X-ray score) decreased and peak oxygen consumption (ml/min per kg) increased significantly from 15.5 +/- 1 (day - 1) to 17.6 +/- 0.9 (day 4), to 17.8 +/- 0.9 (day 30), to 18.9 +/- 1 (day 90) and to 19.1 +/- 1 (day 180). Oxygen consumption at anaerobic threshold (ml/min per kg) also increased significantly from 11.6 +/- 0.8 (day -1) to 13 +/- 0.7 (day 4), to 13.7 +/- 0.5 (day 30), to 15.5 +/- 0.8 (day 90) and to 15.2 +/- 0.8 (day 180). These changes were associated with increased ventilation, tidal volume and dead space/tidal volume ratio at peak exercise. The improvement in exercise performance was associated with a decrease in norepinephrine at rest, a downward shift of norepinephrine kinetics at submaximal exercise and an increase in norepinephrine during orthostatic tilt. None of these changes were recorded in group B.Conclusions. In patients with moderate congestive heart failure, ultrafiltration reduces the severity of the syndrome.