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目的探讨不同置换率的持续静脉-静脉血液滤过(CVVH)治疗急性心肌梗死合并顽固性心衰的临床效果及其对其神经内分泌系统的影响。方法 72例急性心肌梗死合并顽固性心衰患者在常规治疗的基础上给予CVVH治疗,按CVVH治疗置换率不同分为A、B两组,观察两组治疗前后心衰临床表现及心功能心脏指数的变化,并测定治疗前后6、12h左心室射血分数、动脉血气分析、血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、血醛固酮(ALD)、肿瘤坏死因子(TNF-α)、血生化指标及血电解质变化。结果两组患者经CVVH治疗后临床症状得到改善或消失,左心室射血分数显著增加,心功能改善;其中B组总有效率显著高于A组(85.7%VS80%,P<0.05);两组患者血流动力学指标稳定,氧合指数和呼吸频率、心率、平均动脉压、心脏指数(CI)明显改善(P<0.05或P<0.01),其中B组的变化更为显著(P<0.05或P<0.01);两组患者治疗后部分神经内分泌激素如PRA、Ang-Ⅱ、ALD和炎症因子TNF-α等均有明显降低(P<0.05或P<0.01),其中B组的变化更为显著(P<0.05或P<0.01)。结论 CV-VH治疗不失为急性心肌梗死合并顽固性心衰的有效治疗方法 ,高置换率CVVH治疗较低置换率CVVH治疗能更有效的保持患者血流动力学的稳定、能更有效的清除部分神经内分泌激素和炎症因子,因而更有利于改善顽固性心衰。
Objective To investigate the clinical effects of continuous veno-venous hemofiltration (CVVH) with different replacement rates on acute myocardial infarction with refractory heart failure and its effects on the neuroendocrine system. Methods 72 patients with acute myocardial infarction complicated with refractory heart failure were treated with CVVH on the basis of routine treatment. The patients were divided into A and B groups according to the CVVH replacement rate. The clinical manifestations and cardiac function index The changes of left ventricular ejection fraction, arterial blood gas analysis, plasma renin activity (PRA), angiotensin Ⅱ (AngⅡ), aldosterone (ALD), tumor necrosis factor (TNF-α) , Blood biochemical indicators and blood electrolyte changes. Results The clinical symptoms of both groups were improved or disappeared after CVVH treatment, the left ventricular ejection fraction increased significantly and the cardiac function improved. The total effective rate in group B was significantly higher than that in group A (85.7% VS80%, P <0.05) The hemodynamic indexes were stable, the oxygenation index and respiratory rate, heart rate, mean arterial pressure and cardiac index (CI) were significantly improved (P <0.05 or P <0.01), and the changes in group B were more significant (P < 0.05 or P <0.01). After treatment, the levels of some neuroendocrine hormones such as PRA, Ang-Ⅱ, ALD and inflammatory cytokine TNF-α were significantly decreased (P <0.05 or P <0.01) More significant (P <0.05 or P <0.01). Conclusion CV-VH treatment is an effective treatment for patients with acute myocardial infarction complicated with refractory heart failure. High replacement rate CVVH treatment of lower replacement rate CVVH treatment can be more effective in maintaining hemodynamic stability, more effective in clearing part of the nerve Endocrine hormones and inflammatory factors, which is more conducive to improving refractory heart failure.