超滤治疗心衰：现状与未来研究背景ADHERE注册研究AllEnrolledDischargesover12monthsn=52,047InadequateDiuresisDuringADHFTreatmentDespitetheUseofDiureticsin90%ofPatients,20%GainWeightonDischarge1FurosemideMonotherapyCausesSignificantDeclineinRenalFunction(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？DiureticsDilemmaULTRAFILTRATIONallowsfortheproductionofplasmawaterfromwholebloodacrossasemipermeablemembraneinresponsetoatransmembranepressuregradientTheensuingfluidorultrafiltrateisisotonictoplasmaUltrafiltrationcanremovefluidfromthebloodatthesameratethatfluidcanbenaturallyrecruitedfromthetissueThetransientremovalofbloodillicitscompensatorymechanisms,termedplasmaorintravascularrefill(PR),aimedatminimizingthisreduction1,2AHistoryofUltrafiltrationUltrafiltrationcanbedonesafelywithoutsignificantchangesinplasmavolumePlasmarefillratesmaydecreaseasvolumeremovalcontinuesHemodynamicEffectsofUFinCHFUltrafiltrationinChronicCardiacInsufficiency:FailureofFurosemidetoProvidetheSameResultEffectsofUltrafiltrationvsIVFurosemideIsolatedUltrafiltrationProducesaSustainedDecreaseinBodyWeightinHFPatientsEffectsofUltrafiltrationvsIVFurosemideEnhancedSodiumExtractionWithUltrafiltrationComparedWithIntravenousDiureticsUrinevsUFElectrolytesAfterIntravenousDiureticsorUltrafiltrationUltrafiltrationandRenalFunctionStudyNameStudyNameSelectedUltrafiltrationStudiesSummary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,prospectivestudy,21patients(25treatments)InitialUFwithin12hofhospitalizationandbeforeanysignificantadministrationofIVdiureticsand/orvasoactivedrugsPrimaryendpointofgreaterthan1Lfluidremovalinlessthan8hwasachievedin92%oftreatments(treatmentperiod6:43±1:47h:min)Onaverage,2611±1002mL(maximum3725mL)ofultrafiltratewasremovedpertreatmentPatientweightdecreasedfrom91.9±17.5to89.3±17.3kg(P<.0001)afterultrafiltrationNomajoradverseeventsoccurredConclusion:Rapidremovalofextracellularandintravascularfluidvolumeexcesscanbesafelyachievedviaperipherallyinsertedul