超滤for心衰现状未来20110621.pptxVIP

超滤for心衰现状未背景;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 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 achieved in 92% of treatments (treatment period 6:43±1:47 h:min) On average, 2611±1002 mL (maximum 3725 mL) of ultrafiltrate was removed per treatment Patient weight decreased from 91.9±17.5 to 89.3±17.3 kg (P .0001) after ultrafiltration No major adverse events occurred Conclusion: Rapid rem