Valle B K, Valle G A, Lemberg L
Department of Medicine, University of Miami School of Medicine, Fla 33101, USA.
Am J Crit Care. 1995 Mar;4(2):169-73.
CAVH can be effective in severe hypervolemic states, which are generally major hemodynamic abnormalities associated with refractory congestive heart failure, and not infrequently may have a poor renal response to diuretics and vasodilators. Reduced vascular volume with CAVH is accompanied by lower preload and afterload and thus decreased heart size. As a result, cardiac efficiency and contractility improve and oxygen demand is reduced. The temporal progression of congestive heart failure 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 in which 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 congestive heart failure. Thus, the effective use of CAVH in reducing vascular volume and peripheral edema may reverse "refractory" congestive heart failure and prolong life.
连续性动静脉血液滤过（CAVH）对严重容量超负荷状态可能有效，这种状态通常是与难治性充血性心力衰竭相关的主要血流动力学异常，而且对利尿剂和血管扩张剂的肾脏反应常常不佳。CAVH使血管容量减少，同时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。充血性心力衰竭从轻度到重度的进展过程不一定是心肌进行性病变的表现，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、进行性容量超负荷和外周水肿。理解这一概念有助于对充血性心力衰竭的治疗采取更乐观的方法。因此，有效应用CAVH减少血管容量和外周水肿可能逆转“难治性”充血性心力衰竭并延长生命。
