Clinic study on high volume hemofiltration in patients with heart failure combined with diuretic resistance and unstable homodynamic

Abstract

Objective To investigate if high volume hemofiltration (HVHF) is safe and efficient in patients with heart failure combining diuretic resistance and unstable homodynamie,and if there are differences on outcomes between HVHF and diuretic.Methods Eighty congestive heart failure patients with Heart Function class Ⅳ (NYHA) treated in our hospital from April 2006 to January 2008 were divided into HVHF group and diuretic group.The patients in diuretic group (n=40)were treated with the diuretic(lasix is dropped in a speed of 1～5mg/h after 40～60mg is injected,the largest dose of lasix＜1g/d) to decrease the volume burden of heart;The patients in HVHF group (n=40) were carried on HVHF.Others treatments of using drugs were same in tow groups,and dopamine were given to both the tow groups to keep the blood pressure＞90/60 mmHg.Mean artery pressure (MAP),heart rate,the speed of dopamine's transfusion as well as the levels of TNF-α,IL-1β,IL-6、CRP in circumambient blood were recorded pre and post study;Because all of our patients were critical illand can not get up,we put Swan-Ganz catheters in their bodies to monitoring the varieties of homodynamic and evaluated the function of left ventricles straightly.Results There was a gradual increase in HVHF group and decrease in diuretic group of heart rate(P＜0.05).Compared with the diuretic group.the dose of dopamine was gradual decreased in HVHF group (P＜0.05 hand in diuretic group,we had to increase the dose of dopamine to maintain the blood pressure in normal levels.Both CVP and PCWP in two groups were decreased after treatment,but the decrease was more significant in HVHF group (P＜0.05);after treatment,the SV、CO、CL of both groups were increased but the increase was more significant and the patients's homodynamic were more stable in HVHF group compared with the diuretic group (P＜0.05).There were more significant decreases in the levels of TNF-α、IL-1β、IL-6、CRP in circumambient blood in HVHF group than in diuretic group (P＜0.05).Compared with the diuretic group,the levels of Bun、Cr in the plasma were significantly decreased in HVHF group after 12h,the hyponatremia and the hyperkalemia were corrected (P＜0.05).Conclusions HVHF can be effectively used to keep the homodynamic stable by clearing the inflammatory medium of cytokines、water and natrium away from the blood and adjusting the internal environment.Compared with the diuretic group,HVHF is more effective to decreasing the patient's volume burden and can ameliorate the function of heart.It is safe to apply HVHF in patients with heart failure combining diuretic resistance and unstable homodynamic:and has clinical significance to those patients. Key words: High volume hemofiltration; Treatment; Diuretic resjstance; Homodynamic; Congestive heart failure