Isolated ultrafiltration for treatment of cardiac insufficiency in patients with acute myocardial infarction / 中华急诊医学杂志

ABSTRACT

Objective To evaluate the efficacy of isolated ultrafiltration (IUF) for patients with cardiac insufficiency after acut emyocardial infarction (AMI).Methods The acut emyocardial infarction patients admitted from August 2010 to August 2014 were recruited for study.After primary percutaneous coronary intervention (PCI),102 patients presented cardiac insufficiency taking the form of hypotension and acute left heart failure.All heart failure patients dealt with routine medications at first,and were then randomly (random number) divided into two groups,group A was routine medication group and group B was isolated ultrafiltration after routine medication group.Data recorded at different intervals in the same group were analyzed by ANOVA.Data recorded from two groups at the same intervals were analyzed by t test.Data of mortality in the two groups were analyzed by x2 test.P value less than 0.05 was considered statistically significant.Results Of them,51 patients were treated with routine medication resulting in gradual improvement of cardiac function,but the improvement was slower compared with the isolated ultrafiltration group.Other 51 patients were treated with isolated ultrafiltration,and isolated ultrafiltration was discontinued in 2 patients owing to progressive thrombocytopenia and in another one patient owing to systolic blood pressure below 90 mmHg,with clinical manifestations of organ hypoperfusion,poor peripheral circulation,cool clammy skin and oliguria.In the rest of 48 patients in the isolated ultrafiltration group,vital signs were stable,and heart failure symptoms and serum electrolytes improved significantly (P ＜0.05).After one week of using isolated ultrafiltration,left ventricular ejection fraction (LVEF) also improved (P ＜ 0.05).The differences in mortality within one month,the mean ICU stay,the mean hospitalized stay,and the rate of recurrent heart failure were significant between the two groups (P ＜ 0.05)Conclusions The isolated ultrafiltration is a relatively safe and effective strategy for patients with cardiac insufficiency and hypotension after acut emyocardial infarction.