| Objective:To evaluate the therapeutic value of continuous veno-venous hemofiltration (CVVH) in treating fulminant myocarditis (FM).Methods:We retrospectively analyzed 332 patients who stayed in hospital meet the diagnostic criteria of myocartidis, including 75 patients of fulminant myocarditis, 15 patients with poor response to conventional treatment reviewed our experience in treating them with CVVH, all patients collected from March 2007 to December 2009. Each patient were collected the following parameters:①Gender, Age, Duration;②Technology and methods of CVVH: mode of operation, vascular access, anticoagulation method, filter types, etc;③Patients were observed APACHE (Acute Pathophysiology and Chronic Health Evaluation) II score, Troponin, ECG, Echocardiography (left ventricular end diastolic diameter, left ventricular ejection fraction, cardiac output), chest cardiothoracic ratio before and after CVVH; compare CVVH treatment prior to and 24 hours, 48 hours, 72 hours body vital signs (temperature, respiration, heart rate, blood pressure) after CVVH initiated; myocardial enzymes(creatine kinase MB form, lactate dehydrogenase, aspartate aminotransferase, creatine kinase); liver and kidney function(total bilirubin, aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, creatinine, uric acid); electrolyte(potassium); white blood cell; high-sensitivity C-reactive protein;④Compare survival to death cases filtration parameters (total filtrate volume, exchange volume, filtration duration) etc.Results:(1) 15 patients, 9 males (60%) and 6 female patients (40%), ages from 16 to 69 years (37.4±15.6) years. Time from onset to admission of those who died compared with survivors is long, the former was (72.5±33.5)h, the latter was (44.0±31)h, the overall survival rate of 73.3% (11/15).(2) CVVH via Indwelling double lumen central venous catheter to establish cardiopulmonary bypass, jugular vein catheter in 7 cases (47%), femoral vein in 8 cases (53%). Mainly use low molecular weight heparin to anticoagulation, who have bleeding tendency, use no heparin anticoagulant method. Blood filter select AN69 polyacrylonitrile membrane(33.3%) or polysulfone F60(66.7%) (HOSPAL, Industrie-69330, Meyzieu, France).(3) After CVVH treatment APACHE II score decreased significantly, before and after [(17.1±3.3) vs (6.9±3.7), P<0.001]; body temperature, heart rate had improved in some degree, respiration, hemodynamics stabilized after 24 hours, hypotension, shock and other symptoms improved (P<0.001); myocardial enzyme CK-MB, LDH, AST, CK after 24h treatment began to decline, and after 72h decreased significantly (P<0.001), Troponin returned to normal after dialysis. WBC, hs-CRP were significantly lower in 72h (P<0.001), liver and renal function recovered to the normal range after treatment by CVVH, and electrolyte imbalance were corrected later by CVVH. Simultaneously implant aortic balloon pump (IABP) assisted circulation in 8 patients who due to cardiogenic shock, after CVVH treatment which successfully removed, 6 patients ECG showed-like myocardial infarction pattern had coronary angiography (CAG), and both showed normal, 12 patients due to respiratory failure use mechanical ventilation, 8 patients because of AV block and ventricular tachycardia was implanted temporary pacemaker before CVVH, breathing machine and temporary pacemaker were removed after treatment in CVVH. Before and after CVVH 15 patients the LVEDD [(52.6±7.0) vs (47.7±5.8) mm, P <0.05], improved the percentage of 9.0%; CO [(3370±500)vs(4100±400)ml/min,P<0.001], improved the percentage of 21.7%; LVEF improved after CVVH in some degree, improved the percentage of 16.3%; X-ray cardiothoracic ratio [(0.51±0.1)vs(0.47±0),P<0.05], improved the percentage of 7.8%; death and survival capacity of the total filtrate [(3350.0±1167.6)vs(4896.4±865)ml,P<0.05], replacement volume [(1875.0± 477)vs(2758.2±466.2)ml, P<0.01], filtration duration [(33.5±7.5) vs (48.8±11.0) h, P<0.01].(4) 2 patients in the CVVH after cessation of treatment 1 day died due to malignant arrhythmia, 2 patients died due to multiple organ failure.Conclusion:(1) Application of CVVH in 15 patients before compared with after treatment the acute pathophysiology and chronic health score (APACHE II), vital signs(RR, BP), myocardial enzymes, liver and kidney function, electrolytes, WBC, hs-CRP, ECG, echocardiography (LVEDD, CO), chest radiography results improved significantly, the difference was statistically significant.(2) CVVH treatment time is related to increase survival rate of patients with fulminant myocarditis, early and prolonged use of CVVH can improve prognosis and reduce mortality.(3) Application of CVVH treatment in FM patients is a safe, reliable, effective and practical method. |
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