Hypothermia Continuous Renal Replacement Therapy for Severe Heart Failure after Cardiac Surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

趙曉琪 ,  谷天祥 , 喻磊 , 湯銳

中國醫科大學附屬第一醫院心臟外科（沈陽 110001）;

Corresponding?author：

谷天祥, Email: cmugtx@sina.com

Keywords：

持續腎臟替代治療(CRRT); 亞低溫; 心臟外科; 心力衰竭

DOI：

10.7507/1007-4848.20160047

Video：

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目的探討亞低溫聯合持續腎臟替代治療（CRRT）對心臟外科術后重癥心力衰竭的臨床效果方法回顧性分析我中心2009年2月至2013年12月行心臟外科術后重癥心力衰竭38例患者的臨床資料，其中男18例、女20例，年齡55～74歲，雖應用大劑量血管活性藥物及主動脈內球囊反搏（IABP）輔助循環，心力衰竭無改善，采用CRRT及亞低溫聯合治療。監測患者在聯合治療前后心臟指數（CI）值、混合靜脈血氧飽和度（SvO2）、尿量、肌酐（Cr）及乳酸（Lac）的變化。結果亞低溫聯合CRRT治療后，患者CI較治療前明顯改善[（2.3± 0.7）L/（min· m²）vs.（1.8± 0.2）L/（min· m²）]，SvO2升高（62%± 5%vs.50%± 4%），乳酸明顯降低[（8.6± 2.3）mmol/L vs.（3.0± 1.1）mmol/L]，尿量明顯增加[（2.5± 0.9）ml/h vs.（1.0± 0.7）ml/h]，Cr明顯下降[（140± 19）mmol/L vs.（292± 24）mmol/L]。結論亞低溫聯合CRRT治療心臟外科術后重癥心力衰竭能有效改善循環功能，且操作簡單易行。

Citation： 趙曉琪, 谷天祥, 喻磊, 湯銳. Hypothermia Continuous Renal Replacement Therapy for Severe Heart Failure after Cardiac Surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(2): 205-207. doi: 10.7507/1007-4848.20160047 Copy

1.	Habib RH, Zacharias A, Schwann TA, et al. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed? Thorac Cardiovasc Surg, 2003, 125(6): 1438-1450.
2.	Birdi I, Caputo M, Underwood M, et al. Influence of normo-thermic systemic perfusion temperature on cold myocardia protection during coronary artery bypass surgery. Cardiovasc Surg, 1999, 7(3): 369-374.
3.	李承晏, 李濤, 梅志忠, 等.實驗性腦梗死的亞低溫治療時間窗亞低溫開始時間對腦梗死體積的影響.中國危重病急救醫學, 2001, 13(8): 485-487.
4.	李承晏, 劉傳玉, 李濤.亞低溫聯合升壓治療對局灶性腦缺血的腦保護作用.中國危重病急救醫學, 2002, 14(11): 684-685.
5.	Michael E, Lewis MB, John N, et al. The effects of hypothermia on human left ventricular contractile function during cardiac surgery. J Am Coll Cardiol, 2002, 39(1): 102-108.
6.	Duke TD, Butt W, South M. Predictors of mortality and multiorgan failure in children with sepsis. Intensive Care Med, 1997, 33: 684-692.
7.	Hatherill M, McIntyre G, Walter M, et al. Early hyperlactatemia in critically ill children. Intensive Care Med, 2000, 26: 314-318.
8.	Pittard AJ. Does blood lactate measurement have a role in the management of the critically ill patient? Ann Clin Biochem, 1999, 36: 401-407.
9.	Zhao QJ, Zhang XG, Wang LX. Mild hypothermia therapy reduces blood glucose and lactate and improves neurologic outcomes in patients with severe traumatic brain injury. J Crit Care, 2011, 26: 311-315.
10.	李廣斌, 鄭從義, 唐兵, 主編.低溫生物學.長沙:湖南科學技術出版社, 1998. 121-123.
11.	Morariu AM, Loef G, Aarts U, et al. Dexamethasone: benefit and prejudice for patients undergoing coronary artery bypass grafting: a study on myocardial, pulmonary, renal, intestinal and hepatic injury. Chest, 2005, 128(4): 2677-2687.
12.	Sablotzki A, Friedrich I, Muhling J, et al. The systemic inflammatory response syndrome following cardiac surgery: different expression of proinflammatory cytokines and procalcitonin in patients with and without multiorgan dysfunction. Perfusion, 2002, 17(2): 103-109.
13.	解啟蓮, 胡浩天, 安會波.亞低溫對全身炎癥反應小鼠細胞因子與粘附分子表達的影響及意義.中國危重癥急救醫學, 2000, 12(10): 715-716.
14.	劉拉羊, 鄧紅, 趙捷, 等.連續性腎臟替代療法在重癥腎綜合征出血熱少尿期的應用.中國血液凈化, 2002, 1: 19-21.
15.	Wang XX, Guo J, Fang YX, et al. Day extension of the veins-venous hemofiltration in critically ill patients 41 cases of rescue experience(Chinese). China Blood Purification, 2003, 2: 271-273.
16.	Rodriguez JL, Weissman C, Damask MC, et al. Physiologic requirements during rewarming: sup-pression of the shivering response. Crit Care Med, 1983, 11: 490-497.

1. Habib RH, Zacharias A, Schwann TA, et al. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed? Thorac Cardiovasc Surg, 2003, 125(6): 1438-1450.
2. Birdi I, Caputo M, Underwood M, et al. Influence of normo-thermic systemic perfusion temperature on cold myocardia protection during coronary artery bypass surgery. Cardiovasc Surg, 1999, 7(3): 369-374.
3. 李承晏, 李濤, 梅志忠, 等.實驗性腦梗死的亞低溫治療時間窗亞低溫開始時間對腦梗死體積的影響.中國危重病急救醫學, 2001, 13(8): 485-487.
4. 李承晏, 劉傳玉, 李濤.亞低溫聯合升壓治療對局灶性腦缺血的腦保護作用.中國危重病急救醫學, 2002, 14(11): 684-685.
5. Michael E, Lewis MB, John N, et al. The effects of hypothermia on human left ventricular contractile function during cardiac surgery. J Am Coll Cardiol, 2002, 39(1): 102-108.
6. Duke TD, Butt W, South M. Predictors of mortality and multiorgan failure in children with sepsis. Intensive Care Med, 1997, 33: 684-692.
7. Hatherill M, McIntyre G, Walter M, et al. Early hyperlactatemia in critically ill children. Intensive Care Med, 2000, 26: 314-318.
8. Pittard AJ. Does blood lactate measurement have a role in the management of the critically ill patient? Ann Clin Biochem, 1999, 36: 401-407.
9. Zhao QJ, Zhang XG, Wang LX. Mild hypothermia therapy reduces blood glucose and lactate and improves neurologic outcomes in patients with severe traumatic brain injury. J Crit Care, 2011, 26: 311-315.
10. 李廣斌, 鄭從義, 唐兵, 主編.低溫生物學.長沙:湖南科學技術出版社, 1998. 121-123.
11. Morariu AM, Loef G, Aarts U, et al. Dexamethasone: benefit and prejudice for patients undergoing coronary artery bypass grafting: a study on myocardial, pulmonary, renal, intestinal and hepatic injury. Chest, 2005, 128(4): 2677-2687.
12. Sablotzki A, Friedrich I, Muhling J, et al. The systemic inflammatory response syndrome following cardiac surgery: different expression of proinflammatory cytokines and procalcitonin in patients with and without multiorgan dysfunction. Perfusion, 2002, 17(2): 103-109.
13. 解啟蓮, 胡浩天, 安會波.亞低溫對全身炎癥反應小鼠細胞因子與粘附分子表達的影響及意義.中國危重癥急救醫學, 2000, 12(10): 715-716.
14. 劉拉羊, 鄧紅, 趙捷, 等.連續性腎臟替代療法在重癥腎綜合征出血熱少尿期的應用.中國血液凈化, 2002, 1: 19-21.
15. Wang XX, Guo J, Fang YX, et al. Day extension of the veins-venous hemofiltration in critically ill patients 41 cases of rescue experience(Chinese). China Blood Purification, 2003, 2: 271-273.
16. Rodriguez JL, Weissman C, Damask MC, et al. Physiologic requirements during rewarming: sup-pression of the shivering response. Crit Care Med, 1983, 11: 490-497.

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Hypothermia Continuous Renal Replacement Therapy for Severe Heart Failure after Cardiac Surgery

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