连续性静脉–静脉血液滤过(CVVH)在急性心力衰竭中的应用进展

Advances in Continuous Veno-Venous Hemofiltration (CVVH) in Acute Heart Failure

摘要: 急性心力衰竭(简称为急性心衰)是在心脏重症监护室中常见的危急重症之一。最新的指南、专家共识均提出发生急性心衰与容量超负荷有密切的关系，减轻容量负荷、尽快让患者达到干体重状态是其治疗的重点。目前临床上利尿剂的使用是急性心衰治疗的一线药物治疗方法。但在重症监护病房住院治疗的患者病情危重，合并症多，脏器功能较差，尤其是当急性心衰发生时易并发肾功能受损最常见。此时利尿剂的使用常不能纠正患者容量超负荷、心肾功能恶化的恶性循环。在这种情况下连续性的静脉–静脉血液滤过越来越多地被应用于急性心衰患者的治疗中，相比于单纯利尿剂治疗更有效地排除过多的液体，减轻心脏前负荷和症状，纠正电解质酸碱平衡紊乱和内环境稳定，缩短住院时间及降低再住院率。但目前在急性心衰患者中启动连续性静脉–静脉血液滤过治疗的最佳时机仍在争论中及治疗后有关患者预后的报道鲜有。需要进行更多的临床研究来验证连续性的静脉–静脉血液滤过治疗在急性心衰患者中的应用。

Abstract: Acute heart failure (acute heart failure for short) is a common critical illness in intensive care units. The latest guidelines and expert consensus all suggest that the occurrence of acute heart failure is closely related to volume overload, and reducing the volume load and bringing patients to a dry weight state as soon as possible is the focus of its treatment. The use of diuretics is currently the first-line pharmacological treatment for acute heart failure in clinical practice. However, patients hospitalized in intensive care units are in critical condition, with many comorbidities and poor or-gan function; especially when acute heart failure occurs, easily complicated by impaired renal func-tion is the most common. The use of diuretics at this time often fails to correct the vicious cycle of volume overload and deterioration of cardiac and renal function. In this situation, continuous veno-venous hemofiltration is increasingly used in the treatment of patients with acute heart fail-ure, which is more effective than diuretic therapy alone in removing excessive fluid, reducing car-diac preload and symptoms, correcting electrolyte-acid-base balance disorders and stabilizing the internal environment, shortening hospitalization time and reducing rehospitalization rates. How-ever, the optimal time to initiate continuous veno-venous hemofiltration therapy in patients with acute heart failure is still under debate and there are few reports on the prognosis of patients after treatment. More clinical studies are needed to validate the clinical use of continuous veno-venous hemofiltration therapy in patients with acute heart failure.