The Treatment Of Ultrafiltration To The Diuretic Resistance In Patients With Refractory Heart Failure And The Influex Of Pattern Of Syndrome Distribution

Heart failure (HF) is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. The cardinal manifestations of HF are dyspnea and fatigue, which may limit exercise tolerance, and fluid retention, which may lead to pulmonary and/or splanchnic congestion and/or peripheral edema. However, some patients with refractory HF are hospitalized frequently for clinical deterioration, and during such admissions, they commonly receive infusions of both positive inotropic agents(dobutamine, dopamine, or milrinone) and vasodilator drugs(nitroglycerin, nitroprusside, or nesiritide) in an effort to improve cardiac performance, facilitate diuresic, and promote clinical stability. It is called refractory heart failure or end-stage heart failure. In traditional Chinese medical, HF is belong to palpitation and edema and dyspnea. The differentiation of deficiency of vital energy and yang-blood stasis-fluid retention is most essential and common syndrome. It can be treated by benefiting qi for activating blood circulation and warming yang to promote diuresis. Although diuretic therapy is the cornerstone of the treatment of heart failure, hospitalized patients for standardized diuretic treatment are merely26%to dry weight, on account of diuretic resistance and activation of RAAS. Kamer and other German doctors reported the continuous arteriovenous hemofiltration treatment to save a acute renal failure patient in1977firstly, which marks a new birth of blood Purification therapy-a continuous renal replacement therapy expanding another important way and direction of the treatments of heart failure. Compare with diuretic, ultrafiltration has many advantages, for example, it dosent arouse diuretic resistance, electrolyte disturbanee, lacking in strength,and activating the nerve endocrine system.etc However, ultrafiltration also has its disadvantages, such as low blood pressure, Low blood Potassium, short of breathe. It is reported that TMC can improve the diuretic resistance, strengthen the myocardial contraction force, promote healthy blood vessel function and reduce the myocardial oxygen consumption. It is proved that TCM can not only improve effectively the symptom and sign of HF in short time,also be perfect to increase activity tolerance and the quality of life. Hence, the unit of TCM and hemodialysis make more effect to patient. OBJECTIVE:To make sure the effect of hemodialysis to cardiac function, renal function and diuretic resistance. To discuss the effect of hemodialysis of type of syndrome.METHOD:To review the case of hemodialysis in Xiyuan hospital of the China Academy of Chinese Medical Sciences from January1,2011to December31,2013,and record the BNP,Cr, intake and output volume and pattern of syndrome at24hours before and after treatment.RESULT: After treatment, patient of obstinate heart failure has improvement in BNP, urine volume and cardiac functional grading of NYHA. However, renal function is no statistical significance. Yin deficiency syndrome, and yang asthenia increased after treatment. Syndrome of retained fluid decreased. Other TCM syndrome is no statistical significance before and after treatmentCONCLUSION: Hemodialysis decrease the BNP and improve the function of heart and diuretic resistance.But, it does not decrease the renal function. After treatment, in spite of the remission of retention of water, Hemodialysis causes yin-yang deficiency.