超滤for心衰现状未来20110621.pptxVIP

超滤治疗心衰：现状与未来研究;背景;ADHERE注册研究All Enrolled Discharges over 12 monthsn=52,047;Inadequate Diuresis During ADHF Treatment;Despite the Use of Diuretics in 90% of Patients, 20% Gain Weight on Discharge1;Bayliss et al. Br Heart J. 1987;57:17;利尿剂的问题3：降低肾小球滤过率Furosemide cause decline in GFR;Furosemide Monotherapy Causes Significant Decline in Renal Function (GFR);利尿剂的问题3：GFR下降与死亡相关;利尿剂量与死亡增加相关;利尿剂的问题4：增加死亡？; Diuretics Dilemma;ULTRAFILTRATION allows for the production of plasma water from whole blood across a semipermeable membrane in response to a transmembrane pressure gradient The ensuing fluid or ultrafiltrate is isotonic to plasma ;Ultrafiltration can remove fluid from the blood at the same rate that fluid can be naturally recruited from the tissue The transient removal of blood illicits compensatory mechanisms, termed plasma or intravascular refill (PR), aimed at minimizing this reduction1,2 ;A History of Ultrafiltration ;Ultrafiltration can be done safely without significant changes in plasma volume Plasma refill rates may decrease as volume removal continues;Hemodynamic Effects of UF in CHF;Ultrafiltration in Chronic Cardiac Insufficiency: Failure of Furosemide to Provide the Same Result;Effects of Ultrafiltration vs IV Furosemide;Isolated Ultrafiltration Produces a Sustained Decrease in Body Weight in HF Patients;Effects of Ultrafiltration vs IV Furosemide;Enhanced Sodium Extraction With Ultrafiltration Compared With Intravenous Diuretics;Urine vs UF Electrolytes After Intravenous Diuretics or Ultrafiltration;Ultrafiltration and Renal Function;Study Name;Study Name;Selected Ultrafiltration Studies Summary;超滤与利尿剂比较;利尿替代－血液滤过实现的机械利尿;没有心衰专用设备制约了超滤技术在心内科的应用;心衰专用超滤装置的研发;新型心衰专用超滤装置;使用新型设备的临床研究;使用新型设备的临床研究;Multicenter, prospective study, 21 patients (25 treatments) Initial UF within 12 h of hospitalization and before any significant administration of IV diuretics and/or vasoactive drugs Primary end point of greater than 1 L fluid removal in less than 8 h was achi