水分置换疗法

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水分置换疗法（aquapheresis、置换治疗），旨在从一位患有高血容量症(hypervolemia/fluid overload)病征的患者身体以安全地，可以预见地，并有效地移除多馀的盐及水的一种保健医疗技术(Health technology)。

水分置换疗法 Aquapheresis
ICD-9	99.78

水分置换疗法移除患者身体上多馀的盐和水分，并帮助患者恢复的适当的液体平衡(fluid balance/流体平衡)、此即所谓的〈等量体液维持法(euvolemia)〉。

用途

参见：胶体渗透压

水分置换疗法用于治疗一种名为"液体超负荷(流体过载)"和"高血容量症(Hypervolemia)"病征的疗法。液体超负荷可以由许多原因，包括心脏衰竭、肝硬化，高血压和某些肾病变等疾病所引起的。液体超负荷也可以产生于某些外科手术后的预后情况。充血性心脏衰竭是液体超负荷的最常见原因。

运行机制

• 通过一个特殊的过滤器、使用外周或中央静脉导管(Catheter)抽出患者含有过量盐和水的血液。使用一种超滤的形式，该过滤器从血液中分离过量的盐和水。而这些流体(过量的盐和水)被收集在一个袋子里以便之后进行处理，接著将血液再输送回至患者。
• 抗凝血治疗常与水分置换疗法一起使用于防止血液在超滤过滤器上凝固。
• 血液不到一分钟的时间流到体外、且血液流出的总量为33毫升（2.5汤匙）。因此，这是一种体外治疗。
• 最多每小时可除去过量的流体500毫升(1品脱)。平均去除率为每小时250毫升（1/2品脱）。
• 水分置换疗法由三个基本部分组成：一座控制台（具有两个泵浦）、血液过滤电路，以及静脉导管。

注释

• Costanzo MR, Guglin ME, Saltzberg MT, et al. Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol. Feb 2007, 49 (6): 675–83. PMID 17291932. doi:10.1016/j.jacc.2006.07.073. 
• Costanzo MR, Guglin ME, Saltzberg MT, et al. Ultrafiltration is Associated With Fewer Rehospitalizations than Continuous Diuretic Infusion in Patients With Decompensated Heart Failure: Results From UNLOAD. J Card Fail. 2010, 16 (4): 277–84. PMID 20350693. doi:10.1016/j.cardfail.2009.12.009. 
• Costanzo MR, Saltzberg M, O'Sullivan J, Sobotka P. Early ultrafiltration in patients with decompensated heart failure and diuretic resistance. J Am Coll Cardiol. Dec 2005, 46 (11): 2047–51. PMID 16325040. doi:10.1016/j.jacc.2005.05.099. 
• Bart BA, Boyle A, Bank AJ, et al. Ultrafiltration versus usual care for hospitalized patients with heart failure: the Relief for Acutely Fluid-Overloaded Patients With Decompensated Congestive Heart Failure (RAPID-CHF) trial. J Am Coll Cardiol. Dec 2005, 46 (11): 2043–6. PMID 16325039. doi:10.1016/j.jacc.2005.05.098. 
• Jaski BE, Ha J, Denys BG, Lamba S, Trupp RJ, Abraham WT. Peripherally inserted veno-venous ultrafiltration for rapid treatment of volume overloaded patients. Journal of Cardiac Failure. Jun 2003, 9 (3): 227–31. PMID 12815573. doi:10.1054/jcaf.2003.28. 
• Marenzi G, Lauri G, Grazi M, Assanelli E, Campodonico J, Agostoni P. Circulatory response to fluid overload removal by extracorporeal ultrafiltration in refractory congestive heart failure. J Am Coll Cardiol. Oct 2001, 38 (4): 963–8 [2016-08-01]. PMID 11583865. doi:10.1016/S0735-1097(01)01479-6. （原始内容存档于2019-06-06）. 
• Agostoni P, Marenzi G, Lauri G, et al. Sustained improvement in functional capacity after removal of body fluid with isolated ultrafiltration in chronic cardiac insufficiency: failure of furosemide to provide the same result. Am J Med. Mar 1994, 96 (3): 191–9. PMID 8154506. doi:10.1016/0002-9343(94)90142-2. 
• Pepi M, Marenzi GC, Agostoni PG, et al. Sustained cardiac diastolic changes elicited by ultrafiltration in patients with moderate congestive heart failure: pathophysiological correlates. Br Heart J. Aug 1993, 70 (2): 135–40. PMC 1025273 . PMID 8038023. doi:10.1136/hrt.70.2.135. 
• Agostoni PG, Marenzi GC, Pepi M, et al. Isolated ultrafiltration in moderate congestive heart failure. J Am Coll Cardiol. Feb 1993, 21 (2): 424–31. PMID 8426008. doi:10.1016/0735-1097(93)90685-T. 
• S. A. Hunt; W. T. Abraham; M. H. Chin; A. M. Feldman; G. S. Francis; T. G. Ganiats; M. Jessup; M. A. Konstam; D. M. Mancini; et al. 2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation / American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the International Society for Heart and Lung Transplantation. Circulation. 2009, 119 (14): e391–e479 [2016-08-01]. PMID 19324966. doi:10.1161/CIRCULATIONAHA.109.192065. （原始内容存档于2009-05-03）. 
• Lindenfeld J, Albert NM, Boehmer JP, Collins SP, Ezekowitz JA, Givertz MM, Klapholz M, Moser DK, Rogers JG, Starling RC, Stevenson WG, Tang WH, Teerlink JR, Walsh MN. Executive Summary: HFSA 2010 Comprehensive Heart Failure Practice Guideline. J Card Fail. 2010, 16 (6): 475–539 [2016-08-01]. PMID 20610207. doi:10.1016/j.cardfail.2010.04.005. （原始内容存档于2016-10-21）. 
• Kenneth Dickstein; Alain Cohen-Solal; Gerasimos Filippatos; John J.V. McMurray; Piotr Ponikowski; Philip Alexander Poole-Wilson; Anna Stromberg; Dirk J. van Veldhuisen; Dan Atar; Arno W. Hoes; Andre Keren; Alexandre Mebazaa; Markku Nieminen; Silvia Giuliana Priori; Karl Swedberg. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure (PDF). Eur Heart J. 2008, 29 (10): 2388–2442 [2016-08-01]. PMID 18826876. doi:10.1016/j.ejheart.2008.08.005. （原始内容 (PDF)存档于2011-07-26）. 
• JG Howlett; RS McKelvie; JMO Arnold; et al. Canadian Cardiovascular Society Consensus Conference guidelines on heart failure, update 2009: Diagnosis and management of right-sided heart failure, myocarditis, device therapy and recent important clinical trials (PDF). Can J Cardiol. 2009, 25 (2): 85–105 [2016-08-01]. PMC 2691911 . PMID 19214293. doi:10.1016/S0828-282X(09)70477-5. （原始内容 (PDF)存档于2011-07-06）. 

参阅

• 液体平衡(Fluid balance)
• 利尿剂
• 血液分离置换疗法(Apheresis)
• 心脏衰竭
• 高血容量症(Hypervolemia/液体超负荷/Fluid overload)
• 肾超滤作用(Ultrafiltration (renal))
• 超滤

外部链接

• The UNLOAD Study: Ultrafiltration Versus Intravenous Diuretics for Patients Hospitalized for Acute Decompensated Heart Failure. http://www.unloadstudy.com（页面存档备份，存于互联网档案馆）
• Google Search on Aquapheresis: http://www.google.com/search?hl=en&q=aquapheresis