Valle G A, Lemberg L
Department of Medicine, University of Miami School of Medicine, FL 33101.
Heart Lung. 1987 Nov;16(6 Pt 1):712-7.
Continuous arteriovenous hemofiltration can be very effective in severe hypervolemic states associated with refractory CHF and limited renal response to diuretics and vasodilators. A reduced vascular volume is accompanied by a lower preload and afterload and thus a decrease in heart size. As a result cardiac efficiency and contractility improve, and oxygen demands are reduced. The temporal progression of CHF from a mild to a severe state need not be a sign of progressive pathology of heart muscle, but rather a result of feedback circuits where failure begets failure and leads to progressive cardiac enlargement, progressive hypervolemia, and peripheral edema. An appreciation of this concept permits a more optimistic approach to the management of CHF. Thus, the effective use of CAVH in reducing vascular volume and peripheral edema may in some patients reverse "refractory" CHF and prolong life.
持续动静脉血液滤过对于伴有难治性充血性心力衰竭（CHF）以及对利尿剂和血管扩张剂反应有限的严重高血容量状态可能非常有效。血管容量减少伴随着前负荷和后负荷降低，从而心脏大小减小。结果，心脏效率和收缩力提高，氧需求减少。CHF从轻度到重度状态的时间进展不一定是心肌进行性病变的标志，而更可能是反馈回路的结果，即衰竭导致衰竭，并导致进行性心脏扩大、进行性高血容量和外周水肿。认识到这一概念有助于对CHF的管理采取更乐观的方法。因此，在一些患者中有效使用CAVH来减少血管容量和外周水肿可能会逆转“难治性”CHF并延长寿命。
