Experimental and clinical studies on the treatment of intractable heart failure by extracorporeal ultrafiltration method.

在实验性充血性心力衰竭伴二尖瓣返流、冠状动脉闭塞和过度水合的犬模型中研究了体外超滤方法的效果。随着超滤方法的应用，心输出量、每搏作功、全身血管阻力和左心室dp/dt显著增加，同时右心房和左心室充盈压降低。血清电解质在整个手术过程中保持稳定，血清蛋白和红细胞压积水平显著升高。超滤液的组成表明去除了过量的细胞外液。七分之五的心源性休克受试者也受益。实验数据表明，在密切的血流动力学监测下，使用最近开发的高滤过效率的透析器治疗顽固性心力衰竭伴过度水化的临床应用是值得的。采用死腔小、超滤效果好的体外超滤方法，在滤速下效果最好，无副作用50 - 200 ml/hr，持续约10小时，或1000 - 3000 ml/2 - 4小时，每天或在不太紧急的情况下每隔一天。

The effects of the extracorporeal ultrafiltration methods were studied in an experimental canine model of advanced congestive heart failure with mitral regurgitation, coronary artery occlusion and overhydration. With application of the ultrafiltration methods, cardiac output, stroke work, systemic vascular resistance and left ventricular dp/dt increased significantly associated with reduction in the right atrial and left ventricular filling pressure. Serum electrolites were stable throughout the procedure, and there were significant elevations in serum protein and hematocrit levels. The composition of the ultrafiltrate indicated that excessive extracellular fluid was removed. Five out of seven cardiogenic shock subjects also benefited. The experimental data indicated that the clinical application of this approach using recently developed dialyzers with high filtration efficiency to treat intractable heart failure with overhydration under close hemodynamic monitoring was warranted.In the clinical cases with intractable heart failure and overhydrosis, the extracorporeal ultrafiltration method with low dead space and high ultrafiltration effects was applied without side effects most effectively at the filtration rate of 50 - 200 ml/hr over around 10 hours or 1000 - 3000 ml/2 - 4 hours every day or every other day in less urgent cases.