Sheppard Richard, Panyon Jessica, Pohwani Amar L, Kapoor Ajoy, Macgowan Guy, McNamara Dennis, Mathier Michael, Johnston James R, Murali Srinivas
Cardiovascular Institute, University of Pittsburgh Medical Center, Pennsylvania 15213, USA.
J Card Fail. 2004 Oct;10(5):380-3. doi: 10.1016/j.cardfail.2003.12.003.
Patients with severe congestive heart failure (CHF) become refractory to conventional medical therapy, leading to recurrent rehospitalizations. We examined the impact of intermittent outpatient ultrafiltration (UF), using either peritoneal dialysis or hemofiltration, on long-term clinical outcomes in patients with refractory CHF.
We analyzed clinical and hemodynamic data in 19 consecutive patients with refractory CHF who received intermittent outpatient UF for at least 1 year between July 1998 and November 2002. The mean left ventricular ejection fraction of all 19 patients was 30.2 +/- 19.0%. All patients (100.0%) were New York Heart Association (NYHA) class IV. Only 5 patients (26.3%) received peritoneal dialysis; the remaining 14 (73.7%) received hemofiltration. There were 6 patients with a normal left ventricular ejection fraction (45%). After UF was started, the number of patients that were considered inotrope-dependent was reduced from 86.4% to 36.8% (P < .005). Compared with the year before UF was initiated, the number of CHF hospitalizations during follow-up was reduced from 2.6 to 0.3 (P < .005), and the NYHA class was improved from 4 to 3.1 (P < .005). Among all patients, 2 deaths were related to complications of UF, and cumulative 1-year survival was 63.2%.
Our study suggests that UF is a safe, feasible therapy, but it needs further evaluation in carefully designed, prospective, randomized clinical trials. UF has the potential for offering another important therapeutic option for patients with severe and refractory CHF.
重度充血性心力衰竭（CHF）患者对传统药物治疗产生耐药性，导致反复住院。我们研究了采用腹膜透析或血液滤过的间歇性门诊超滤（UF）对难治性CHF患者长期临床结局的影响。
我们分析了1998年7月至2002年11月期间连续接受间歇性门诊UF至少1年的19例难治性CHF患者的临床和血流动力学数据。所有19例患者的平均左心室射血分数为30.2±19.0%。所有患者（100.0%）均为纽约心脏协会（NYHA）IV级。仅5例患者（26.3%）接受腹膜透析；其余14例（73.7%）接受血液滤过。有6例患者左心室射血分数正常（45%）。开始UF后，依赖血管活性药物的患者数量从86.4%降至了36.8%（P <.005）。与开始UF前的一年相比，随访期间CHF住院次数从2.6次降至了0.3次（P <.005），NYHA分级从4级改善至3.1级（P <.005）。在所有患者中，2例死亡与UF并发症相关，1年累计生存率为63.2%。
我们的研究表明，UF是一种安全、可行的治疗方法，但需要在精心设计的前瞻性随机临床试验中进一步评估。UF有可能为难治性重度CHF患者提供另一种重要的治疗选择。
