nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2010-14-1-63-67nefr-1204Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSОПЫТ ПРИМЕНЕНИЯ SUSTAINED LOW EFFICIENCY DIALYSIS (SLED) - ТЕХНОЛОГИЙ ЗАМЕСТИТЕЛЬНОЙ ПОЧЕЧНОЙ ТЕРАПИИ В ЛЕЧЕНИИ КАРДИОРЕНАЛЬНОГО СИНДРОМА С ДИУРЕТИК-РЕФРАКТЕРНЫМИ ОТЕКАМИEXPERIENCE OF SUSTAINED LOW EFFICIENCY DIALYSIS (SLED) - METHODS RENAL REPLACEMENT THERAPY IN TREATMENT CARDIORENAL SYNDROME WITH DIURETIC-REFRACTORY EDEMASМухоедоваТ. В.MukhoedovaT. V.

Отделение гемодиализа и  экстракорпоральной детоксикации

630055, г.Новосибирск, ул. Речкуновская, д.15, тел.: (8-383)332-76-22.

mukhoedova@mail.ruУнароковЗ. М.UnarokovZ. M.

Отделение гемодиализа и  экстракорпоральной детоксикации

Новосибирский научно-исследовательский инсти­тут патологии кровообращения им. акад. Е.Н.МешалкинаRussian Federation2010100120101416367Copyright © Мухоедова Т.В., Унароков З.М., 20102010Мухоедова Т.В., Унароков З.М.Mukhoedova T.V., Unarokov Z.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/1204

ЦЕЛЬ ИССЛЕДОВАНИЯ. Оценить эффективность и безопасность гибридных методов заместительной почечной терапии в лечении диуретик-рефрактерной объемной перегрузки при острой декомпенсации хронической сердечной недостаточности. ПАЦИЕНТЫ И МЕТОДЫ. Пролечено 14 кардиохирургических больных в до- и послеоперационном периоде с острой объемной перегрузкой и массивными диуретик-рефрактерными отёками на фоне острой декомпенсации ХСН III–IV ФК по классификации NYHA. Проводилась гемофильтрация/гемодиафильтрация online в режиме sustained low efficiency dialysis (SLED) по адаптированной технологии, с удалением избыточной жидкости 2457±128 мл за сеанс, а также использование низких потоков диализата/субституата и безацетатного раствора «Кребсол». РЕЗУЛЬТАТЫ. В 13 случаях достигнута стабильная регрессия объемной перегрузки, включая периферических отёки, улучшение центральной гемодинамики, водовыделительной функции почек и чувствительности к диуретикам. ЗАКЛЮЧЕНИЕ. SLED-технологии могут быть достаточно эффективным методом в лечении диуретик-рефрактерных отёков у больных с острой декомпенсацией ХСН. Адаптированный режим лечения, включающий ультрафильтрацию под контролем опции online мониторинга объёма циркулирующей крови (BVM), использование самых низких потоков диализата/субституата (6 л/ч) и применение полностью безацетатного раствора «Кребсол», позволил значительно снизить риск осложнений у больных со спровоцированной гемодинамикой.

THE AIM. To evaluate an efficiency and safety of SLED-HF/HDF (hybrid methods of renal replacement therapy) in patients with congestive heart failure and refractory volume overload. PATIENTS AND METHODS. Fourteen patients with acute decompensated heart failure and acute volume overload and diuretic-refractory edemas were given SLED-HF/HDF before and after cardiac surgery. Parametrs SLED-HF/HDF including: fluid removal 2457±128 ml during procedure, using low dialysatе flow and acetate-free dialysatе («Krebsol»). RESULTS. Edemas’ and volume overloads regression, improvement of central and pulmonal hemodynamic and renal dysfunctions were achieved in 13 patients. CONCLUSION. Adapted parameters SLED-therapy including on-line blood volume monitoring, using low dialysatе flow (6 l/hour), acetate-free dialysatе («Krebsol») allowed to reduce complications (hypothensia and arrhythmia).

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The authors declare that there are no conflicts of interest present.