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首页> 外文期刊>Journal of cardiac failure >Prompt reduction in intra-abdominal pressure following large-volume mechanical fluid removal improves renal insufficiency in refractory decompensated heart failure.
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Prompt reduction in intra-abdominal pressure following large-volume mechanical fluid removal improves renal insufficiency in refractory decompensated heart failure.

机译：大量去除机械液后迅速降低腹腔内压力可改善难治性代偿性心力衰竭的肾功能不全。

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BACKGROUND: Our group recently reported that elevated intra-abdominal pressure (IAP, defined as > or = 8 mm Hg) can be associated with renal dysfunction in patients with advanced decompensated heart failure (ADHF). We hypothesize that in the setting of persistently elevated IAP and progressive renal insufficiency refractory to intensive medical therapy, mechanical fluid removal can be associated with improvements in IAP and renal function. METHODS AND RESULTS: The renal and hemodynamic profiles of 9 consecutive, volume-overloaded subjects with ADHF and elevated IAP, refractory to intensive medical therapy, were prospectively collected. All subjects experienced progressive elevation of serum creatinine and IAP in response to intravenous loop diuretics. Within 12 hours after mechanical fluid removal via paracentesis (n = 5, mean volume removed 3187 +/- 1772 mL) or ultrafiltration (n = 4, mean volume removed 1800 +/- 690 mL), there was a significant reduction in IAP (from 13 +/- 4 mm Hg to 7 +/- 2 mm Hg, P = .001), with corresponding improvement in renal function (serum creatinine from 3.4 +/- 1.4 mg/dL to 2.4 +/- 1.1 mg/dL, P = .01) without significantly altering any hemodynamic measurement. CONCLUSION: In volume-overloaded patients admitted with ADHF refractory to intensive medical therapy, we observed a reduction of otherwise persistently elevated IAP with corresponding improvement in renal function after mechanical fluid removal.
机译：背景：我们的小组最近报道，晚期失代偿性心力衰竭（ADHF）患者的腹腔内高压升高（IAP，定义为≥8 mm Hg）可能与肾功能不全有关。我们假设在IAP持续升高和进行性药物治疗难以治疗的进行性肾功能不全的情况下，机械性积液的清除可与IAP和肾功能的改善相关。方法和结果：前瞻性收集了9例连续，超负荷ADHF和IAP升高的患者的肾脏和血液动力学特征，这些患者难以接受强化药物治疗。所有受试者均响应静脉loop利尿剂经历了血清肌酐和IAP的逐步升高。在通过穿刺术（n = 5，去除的平均体积3187 +/- 1772 mL）或超滤（n = 4，去除的平均体积1800 +/- 690 mL）的机械液去除后12小时内，IAP显着降低（从13 +/- 4 mm Hg增至7 +/- 2 mm Hg，P = .001），肾功能得到相应改善（血清肌酐从3.4 +/- 1.4 mg / dL增至2.4 +/- 1.1 mg / dL ，P = 0.01），而不会显着改变任何血液动力学测量结果。结论：在接受重症监护治疗的难治性ADHF患者中，超负荷的患者在机械液清除后，IAP持续降低，IAP降低，肾功能相应改善。

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