Study in the protective role of continuous veno-venous hemofiltration in patients with diuretic-ineffective cardiac insufficiency

Abstract

Objective To study the protective role of continuous veno-venous hemofiltration (CVVH) in cardiac insufficiency refractory to diuretic therapy after acute myocardial infarction. Methods A total of 104 acute myocardial infarction patients admitted from march 2012 to march 2016 were recruited. According to their wishes, the patients were divided into two groups, continuous veno-venous hemofiltration combined with routine therapy as experimental group (n=52) and conventional treatment as control group (n=52). Mortality rate within one month, the mean length of ICU stay, the mean length of hospital stay, ventilator usage and urine output volume were documented. Then the difference in BW between pre- and post-treatment was determined for evaluation of fluid retention, and blood plasma C-reactive protein (ΔCRP), interleukin 6 (ΔIL-6), interleukin 8 (ΔIL-8), tumor necrosis factor-α (ΔTNF-α) and left ventricular ejection fraction (ΔLVEF) were measured and calculated. A multiple linear regression model to predict ΔLVEF was established. Data recorded at different intervals in the same group were analyzed by ANOVA. Data of the monitoring biomarkers, the mean length of ICU stay, the mean length of hospital stay of two groups were recorded at the same given intervals were analyzed by t test. Data of mortality rate within one month, drugs and ventilator usage in two groups were analyzed by χ2 test . P value less than 0.05 was considered statistically significant. Results There were significant differences in mortality rate within one month, the mean length of ICU stay, the mean length of hospital stay, and the duration of ventilator usage between the two groups (P 0.05) as compared with those before the treatment.BW was decreased and LVEF was increased in both groups after treatment (P 0.05). However, the degrees of ΔLVEF andΔBW were greater in experiment group than those in control group (P 0.05). Multiple 1inear regression analyses showed that only ΔBW was the independent factor for ΔLVEF. Conclusion CVVH plays protective role in acute myocardial infarction patients with consequent cardiac insufficiency refractory to diuretic therapy by clearance of inflammatory cytokines and removal of retained fluid, and the removal of retained fluid is the most import mechanism to protect heart function. Key words: Continuous veno-venous hemofiltration; Acute Myocardial infarction; Acute Myocardial infarction patients with cardiac insufficiency; Diuretic resistance; Left ventricular ejection fraction; Retained fluid; Inflammatory cytokines; Study on the mechanism