【摘要】 目的探讨连续性血液净化(continuous veno-venous hemofiltration,CVVH)治疗用于心脏移植术前准备的作用。方法回顾性分析1例接受心脏移植的患者应用CVVH为术前准备的临床资料,着重分析CVVH的治疗方法和疗效。患者术前诊断:限制型心肌病,心功能为纽约心脏协会心功能Ⅳ级。患者反复心力衰竭并渐进性发展,出现轻度肾前性肾功能衰竭。给予CVVH3d,25d后进行心脏移植术。血液净化治疗模式为CVVH。治疗持续时间12h/d,超滤2000～2200mL/d。结果 CVVH治疗后恶心、呕吐、腹胀等症状明显缓解,恢复正常尿量,双肺湿啰音、腹水征消失;生化参数转正?谎蛊轿龋芑钚砸┪镉昧棵飨约跎佟?心脏移植术后前5d尿量保持在2800mL/d以上,未出现严重右心衰竭及感染,术后6d转出监护室回普通隔离病房继续治疗。结论肾功能衰竭发生在心脏移植术前多为肾前性肾功能衰竭,往往都是可逆的,尽早应用CVVH是一种积极有效的措施。CVVH做为心脏移植术前准备,并非只适用于合并严重肾功能衰竭患者。更多还原

【Abstract】 Objectives To discuss the effect of continuous veno-venous hemofiltration (CVVH) in preparation for heart transplantation.Methods We retrospectively analyzed a case who performed CVVH before heart transplantation ,focused on the methods and curative effect of CVVH.The case was with restrictive cardiomyopathy ,New York heart association heart function Ⅳ,appeared obstinate heart failure and perennial inadequacy.He improved heart function by CVVH ( treated 12 hours per day,for 3 days,ultrafiltrated 2 000～2 200 mL / d,25 days before heart transplantation ).Results After the treatment of CVVH,the case relieved from nausea,vomit and abdominal distention.Urinary production was recovered.The sign of bubble and ascites was disappeared.The biochemistry analysis was normal.The vital sign was stable.The dose of vasoactive agent was decreased obviously.After the heart transplantation ,the urinary production maintain 2 800 mL / d in the first 5 days.The patient returned to isolation ward on the 6th day,without serious right heart failure and infection.Conclusions The renal insufficiency before heart transplantation is prerenal insufficiency usually.It is reversible,so we should adopt active measure just as CVVH.CVVH is used for the preparation of heart transplantation not only in patients with serious renal insufficiency.更多还原