Blake P, Paganini E P
Cleveland Clinic Foundation, OH 44195-5176, USA.
Adv Ren Replace Ther. 1996 Apr;3(2):166-73. doi: 10.1016/s1073-4449(96)80057-4.
Congestive heart failure (CHF) from ischemic cardiomyopathy has emerged as an epidemic health problem. The pathogenesis of CHF is characterized by heightened activity of many neuroendocrine factors, including norepinephrine, angiotensin II, and arginine vasopressin, which lead to heightened systemic vascular resistance and further impedance of left ventricular ejection. Once CHF reaches New York Heart Association (NYHA) class III or IV with heightened activity of the many neurohumoral factors, it tends to be refractory to conventional therapy of vasodilators, inotropic agents, and diuretics. Treatment of refractory CHF appears to require a break in the neurohumoral hemodynamic vicious cycle, and ultrafiltration appears able to produce this interruption. Ultrafiltration has been shown to be successful in patients with NYHA class III to VI CHF and urine output less than 1,000 mL/d. It relieves pulmonary edema, reduces ascites and peripheral edema, and enhances the response to subsequent diuretic therapy. In patients with refractory CHF, the ability to provide adequate volume removal, thus improving overall volume status, normalizing filling pressures, and reducing clinical symptoms, offers an improvement in overall quality of life. Early results have shown that ongoing therapy actually may be associated with decreased hospital readmissions or, at the very least, shortened intensive care unit length of stay.
缺血性心肌病引起的充血性心力衰竭（CHF）已成为一个流行的健康问题。CHF的发病机制以多种神经内分泌因子活性增强为特征，包括去甲肾上腺素、血管紧张素II和精氨酸加压素，这些因子导致全身血管阻力增加，进一步阻碍左心室射血。一旦CHF发展到纽约心脏协会（NYHA）III级或IV级，且多种神经体液因子活性增强，它往往对血管扩张剂、正性肌力药物和利尿剂的传统治疗产生耐药性。难治性CHF的治疗似乎需要打破神经体液血液动力学恶性循环，而超滤似乎能够产生这种阻断作用。超滤已被证明对NYHA III至VI级CHF且尿量少于1000 mL/d的患者有效。它可缓解肺水肿，减少腹水和外周水肿，并增强后续利尿治疗的效果。对于难治性CHF患者，能够充分清除液体，从而改善总体容量状态、使充盈压正常化并减轻临床症状，可提高整体生活质量。早期结果表明，持续治疗实际上可能与减少再次入院率相关，或者至少缩短重症监护病房住院时间。
