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

Authors：

赵晓琪 ,  谷天祥 , 喻磊 , 汤锐

中国医科大学附属第一医院心脏外科（沈阳 110001）;

Corresponding author：

谷天祥, Email: cmugtx@sina.com

Keywords：

持续肾脏替代治疗(CRRT); 亚低温; 心脏外科; 心力衰竭

DOI：

10.7507/1007-4848.20160047

Video：

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目的探讨亚低温联合持续肾脏替代治疗（CRRT）对心脏外科术后重症心力衰竭的临床效果方法回顾性分析我中心2009年2月至2013年12月行心脏外科术后重症心力衰竭38例患者的临床资料，其中男18例、女20例，年龄55～74岁，虽应用大剂量血管活性药物及主动脉内球囊反搏（IABP）辅助循环，心力衰竭无改善，采用CRRT及亚低温联合治疗。监测患者在联合治疗前后心脏指数（CI）值、混合静脉血氧饱和度（SvO2）、尿量、肌酐（Cr）及乳酸（Lac）的变化。结果亚低温联合CRRT治疗后，患者CI较治疗前明显改善[（2.3± 0.7）L/（min· m²）vs.（1.8± 0.2）L/（min· m²）]，SvO2升高（62%± 5%vs.50%± 4%），乳酸明显降低[（8.6± 2.3）mmol/L vs.（3.0± 1.1）mmol/L]，尿量明显增加[（2.5± 0.9）ml/h vs.（1.0± 0.7）ml/h]，Cr明显下降[（140± 19）mmol/L vs.（292± 24）mmol/L]。结论亚低温联合CRRT治疗心脏外科术后重症心力衰竭能有效改善循环功能，且操作简单易行。

Citation： 赵晓琪, 谷天祥, 喻磊, 汤锐. 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, 李涛, 梅志忠, 等.实验性脑梗死的亚低温治疗时间窗亚低温开始时间对脑梗死体积的影响.中国危重病急救医学, 2001, 13(8): 485-487.
4.	李承晏, 刘传玉, 李涛.亚低温联合升压治疗对局灶性脑缺血的脑保护作用.中国危重病急救医学, 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.	李广斌, 郑从义, 唐兵, 主编.低温生物学.长沙:湖南科学技术出版社, 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.	解启莲, 胡浩天, 安会波.亚低温对全身炎症反应小鼠细胞因子与粘附分子表达的影响及意义.中国危重症急救医学, 2000, 12(10): 715-716.
14.	刘拉羊, 邓红, 赵捷, 等.连续性肾脏替代疗法在重症肾综合征出血热少尿期的应用.中国血液净化, 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, 李涛, 梅志忠, 等.实验性脑梗死的亚低温治疗时间窗亚低温开始时间对脑梗死体积的影响.中国危重病急救医学, 2001, 13(8): 485-487.
4. 李承晏, 刘传玉, 李涛.亚低温联合升压治疗对局灶性脑缺血的脑保护作用.中国危重病急救医学, 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. 李广斌, 郑从义, 唐兵, 主编.低温生物学.长沙:湖南科学技术出版社, 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. 解启莲, 胡浩天, 安会波.亚低温对全身炎症反应小鼠细胞因子与粘附分子表达的影响及意义.中国危重症急救医学, 2000, 12(10): 715-716.
14. 刘拉羊, 邓红, 赵捷, 等.连续性肾脏替代疗法在重症肾综合征出血热少尿期的应用.中国血液净化, 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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