心衰超滤脱水装置治疗急性失代偿性心力衰竭伴利尿剂抵抗患者的有效性及安全性评价
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(解放军总医院心血管内科,北京 100853)

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R457

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解放军总医院临床科研扶持基金(2015FC-TSYS-2004)


Efficacy and safety of a novel ultrafiltration device for acute decompensated heart failure with diuretic resistance
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(Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China)

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    摘要:

    目的 评估心衰超滤脱水装置(FQ-16)用于急性失代偿性心力衰竭(ADHF)伴利尿剂抵抗患者的安全性和有效性。方法 回顾性分析2015年11月至2017年6月解放军总医院心血管内科通过FQ-16心衰超滤脱水装置进行超滤治疗的ADHF伴利尿剂抵抗患者35例,比较超滤治疗前和最后一次超滤结束后患者体质量、收缩压(SBP)、舒张压(DBP)、血肌酐(SCr)、血尿素氮(BUN)、心率(HR)、血红蛋白(Hb)、血小板(PLT)、红细胞比容(Hct)、呼吸困难评分、中心静脉压(CVP)、血氧饱和度(SaO2)、N末端脑钠肽前体(NT-proBNP)、左室射血分数(LVEF)等指标和主要不良事件的发生情况。采用SPSS 17.0软件进行数据分析。数据采用t检验比较组间差异。结果 超滤治疗前和最后一次超滤治疗后患者SBP、DBP、HR、SCr、BUN、Hb、Hct、PLT、K+、Na+和Cl-等方面差异无统计学意义(P>0.05)。相比超滤治疗前,最后一次超滤治疗后患者体质量、呼吸困难评分、SaO2、CVP和NT-proBNP均改善,差异有统计学意义(P<0.05)。超滤治疗期间和超滤治疗后72 h内未发生死亡、心肌梗死、心力衰竭加重等不良事件,治疗期间未发生有治疗意义的低血压。2例高龄患者超滤治疗前后神智淡漠,超滤结束后24 h内完全恢复。结论 心衰超滤脱水装置FQ-16可缓解ADHF伴利尿剂抵抗患者的液体潴留和呼吸困难,对血压、电解质、肾功能无影响,未见严重不良事件发生,疗效安全、可靠。

    Abstract:

    Objective To evaluate the efficacy and safety of a novel ultrafiltration device (FQ-16) in patients with acute decompensated heart failure and diuretic resistance. Methods A retrospective study was carried out on 35 patients with acute decompensated heart failure and diuretic resistance who were hospitalized in our department from November 2015 to June 2017. They were treated using a new ultrafiltration device (FQ-16). The body weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), serum creatinine (SCr), blood urea nitrogen (BUN), heart rate (HR), hemoglobin (Hb), platelet (PLT) count, hematocrit (Hct), dyspnea score, central venous pressure (CVP), arterial oxygen saturation (SaO2), N-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF) before and after the ultrafiltration treatment, and the incidence of major adverse event were measured and observed to evaluate the clinical efficiency and safety. Clinical data were analyzed by SPSS statistics 17.0. The differences were compared with t test. Results No significant differences were found in SBP, DBP, HR, SCr, BUN, Hb, Hct, PLT, K+,Na+ and Cl- level before and after the last ultrafiltration (P>0.05). But body mass, dyspnea score, SaO2, CVP and NT-proBNP were improved obviously (P<0.05). During and within 72 h after the ultrafiltration, no death, myocardial infarction or aggravation of heart failure was observed, neither treatment-required hypotension occurred. Two very old patients experienced conscious disturbance in the treatment, and relieved in 24 h after ultrafiltration. Conclusion The novel ultrafiltration device FQ-16 adequately relieves hypervolemia and dyspnea, but has no effect on blood pressure, electrolytes, and renal function in patients with acute decompensated heart failure and diuretic resistance. No serious adverse events were observed. It is an effective and safe therapeutic method.

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李佳月,董蔚,戈程,李宗斌,朱梅,胡鑫,张艳.心衰超滤脱水装置治疗急性失代偿性心力衰竭伴利尿剂抵抗患者的有效性及安全性评价[J].中华老年多器官疾病杂志,2017,16(9):649~653

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  • 收稿日期:2017-06-08
  • 最后修改日期:2017-07-10
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  • 在线发布日期: 2017-09-26
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