超滤治疗心力衰竭中国专家建议介绍.pptx

冯新庆 中国中医科学院西苑医院2015-10-30;背景;背景;背景;钠在CHF中的重要作用;钠在CHF中的重要作用;钠在CHF中的重要作用;钠在CHF中的重要作用;利尿剂面临的挑战和超滤概念的建立;利尿剂面临的挑战和超滤概念的建立;利尿剂面临的挑战和超滤概念的建立;心力衰竭超滤技术的进步;心力衰竭超滤技术的进步;心力衰竭超滤技术的进步;心力衰竭超滤技术的进步;心力衰竭超滤技术的进步;超滤治疗的限制;超滤的技术优势;超滤的排钠能力最强;不同治疗方法的排钠能力比较;超滤的血液动力学作用;Hemodynamic Effects of UF in CHF;16 stable, NYHA II-III chronic HF patients matched by age, gender and peak VO2 Randomized to isolated ultrafiltration (500 cc/h) or IV furosemide Removal of the same amount of fluid in both arms (≈ 1,600 cc) Measurement of hemodynamics, peak VO2, NE, PRA and Aldosterone at baseline, end of treatment and 3 months;Ultrafiltration vs. Furosemide in HF;Agostoni PG et al. Am J Med 1994; 96:191-9; Pathophysiologic pathways underlying CHF and renal dysfunction. UF could potentially counter certain adverse cardiorenal Interactions and break the vicious cycle.;;超滤治疗的安全性;;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 elicits a compensatory mechanism, called plasma or intravascular refill (PR), aimed at minimizing this reduction1,2 ;Marenzi et al. J Am Coll Cardiol. 2001;38:963-968.;超滤治疗的安全性;Mullens, W. et al. J Am Coll Cardiol 2009;53:589-596;超滤治疗的安全性;;超滤治疗的适应症;超滤治疗的适应症;超滤治疗的适应症;;;超滤治疗的适应症;;超滤治疗的适应症;体外超滤治疗禁忌症;超滤治疗的实施规范;超滤治疗的实施规范;;超滤治疗的实施规范;;小结;THANKS For Your Attention;超滤治疗CHF临床试验;随机对照临床试验;非对照临床试验;Ultrafiltration versus IV Diuretics for Patients Hospitalized for Acute Decompensated Congestive Heart Failure: A Prospective Randomized Clinical TrialUNLOAD Trial;Freedom From Re-hospitalization for Heart Failure;Cardiorenal Rescue Study in Acute Decompensated Heart Failure ,CARRESS-HF;CARRESS-HF:96H体重和肌酐;CARRESS-HF：肌酐;CARRESS-HF：不良事件;;中国心力衰竭指南2014;;Guidelines Update for the Use of UF in HF;Guidelines Update for the Use of UF in HF;Managing Volume Overload in Acute Decompensated Heart Failure：Conclusions ;;EUPHORIA Trial: Length of Stay;;EUPHORIA Trial: Conclusions;UNLOAD研究：超滤减少再住院44%，减少看急诊