作　　者： (李红艳）; (秦历杰）; (芦良花）;

机构地区： 河南省人民医院急诊科,郑州450003

出　　处： 《中华急诊医学杂志》 2017年第8期929-934,共6页

摘　　要： 目的 探讨连续性静脉-静脉血液滤过（CVVH）改善急性心肌梗死后利尿剂抵抗心衰的疗效及机制。方法 选取2012年3月～2016年3月在河南省人民医院急诊科重症监护病房、重症医学科住院的急性心肌梗死后利尿剂抵抗心衰患者104例，根据患者意愿，分为连续性静-静脉血液滤过联合常规药物治疗组52例为试验组，常规药物治疗组52例为对照组。记录治疗前后尿量；测量治疗48h前后体质量（BW，用于评价患者液体潴留程度），血浆C-反应蛋白（CRP）、白细胞介素6（IL-6）、白细胞介素8（IL-8）、肿瘤坏死因子a（TNF-a）水平，以及左心室射血分数（LVEF），计算上述指标的改变量（△CRP、△IL-6、△IL-8、△TNF-a），建立预测△LVEF的多元线性回归模型。结果 2组患者1个月病死率、平均重症监护时间、平均住院时间及呼吸机使用情况差异均具有统计学意义（P〈0.05）。两组治疗后48h，试验组液体排出总量（尿量＋超滤量）超过对照组（P〈0.001）。治疗48h后与治疗前比较，试验组CRP、IL-6、IL-8、TNF-a水平下降（P〈0.05），对照组CRP、IL-6、IL-8、TNF-a水平略有下降，但无统计学意义（P〉0.05），两组体质量均较治疗前下降（P〈0.05），两组LVEF较治疗前升高（P〈0.05）；两组之间比较，试验组CRP、IL-6、IL-8、TNF-a水平低于对照组（P〈0.05），体质量略低于对照组、LVEF略高于对照组，但均无统计学意义（P〉0.05）；试验组体质量下降值（△BW）、LVEF的升高值（△LVEF）均超过对照组（P〈0.001）。试验组△BW、△CRP、△IL-6、△ IL-8与△LVEF呈正相关（P〈0.05），多元线性回归模型显示，△BW、△TNF-a是△LVEF的独立影响因子，其中△BW是主要影响因子。对照组△BW与△LVEF呈正相关（P〈0.001），△CRP、△IL-6、△IL-8、△TNF-a与△LVEF无相关性（P〉0.05），只有△BW被纳入△LVEF的� Objective To study the protective role of continuous veno-venous hemofiltration （CVVH） in cardiac insufficiency refractory to diuretic therapy after acute myocardial infarction. Methods ,A total of 104 acute myocardial infarction patients admitted from march 2012 to march 2016 were recruited. According to their wishes, the patients were divided into two groups, continuous veno-venous hemofiltration combined with routine therapy as experimental group （ n = 52 ） and conventional treatment as control group（n =52）. Mortality rate within one month, the mean length of ICU stay, the mean length of hospital stay, ventilator usage and urine output volume were documented. Then the difference in BW between pre- and post-treatment was determined for evaluation of fluid retention, and blood plasma C-reactive protein （ACRP） , interleukin 6 （AIL-6）, interleukin 8 （AIL-8）, tumor necrosis factor-a（ATNF-a） and left ventricular ejection fraction （ALVEF） were measured and calculated. A multiple linear regression model to predict ALVEF was established. Data recorded at different intervals in the same group were analyzed by ANOVA. Data of the monitoring biomarkers, the mean length of ICU stay, the mean length of hospital stay of two groups were recorded at the same given intervals were analyzed by t test. Data of mortality rate within one month, drugs and ventilator usage in two groups were analyzed by X2 test . P value less than 0. 05 was considered statistically significant. Results There were significant differences in mortality rate within one month, the mean length of ICU stay, the mean length of hospital stay, and the duration of ventilator usage between the two groups （ P 〈 0. 05 ）. Total volume of fluid output （ urine and uhrafiltration volmne） was higher in experiment group than that in control group in 48 hours after the treatment （P 〈 0. 01 ）. The levels of CRP, IL-6, IL-8 and TNF-ct decreased significantly （P 〈 0. 05 ） in experiment group after treatment but not in cont

关 键 词： 血液滤过 急性心肌梗死 心梗后心衰 利尿剂抵抗 左心室射血分数 液体潴 留 炎症因子 机制分析