摘要
目的分析连续性肾脏替代疗法(CRRT)挽救治疗肾功能衰竭并急性失代偿性充血性心力衰竭(ADHF)的可行性。方法回顾性分析2019年1月至2021年6月濮阳市人民医院收治的64例肾功能衰竭并ADHF患者的临床资料,根据治疗方法分为对照组(30例)和观察组(34例)。对照组采用间歇性血液透析治疗,观察组采用CRRT治疗,比较两组临床疗效、肾功能指标[血肌酐(Scr)、尿素氮(BUN)、胱抑素C(CysC)]、心功能指标[左心室射血分数(LVEF)、左室舒张末期容积指数(LVEDV)、左室收缩末期容积指数(LVESVI)]、血流动力学指标[氧合指数(PaO2/FiO2)、平均动脉压(MAP)、心率(HR)]、炎症指标[降钙素原(PCT)、白细胞计数(WBC)、C反应蛋白(CRP)]、不良反应发生率及1年存活率。结果观察组治疗有效率(94.12%,32/34)高于对照组(70.00%,21/30),P<0.05。治疗后,两组Scr、BUN、CysC水平均降低(P均<0.05),且观察组Scr、BUN、CysC水平均低于对照组(P均<0.05);两组LVEF均升高,LVEDVI、LVESVI均降低(P均<0.05),且观察组LVEF高于对照组,LVEDVI、LVESVI低于对照组(P<0.05);两组PaO2/FiO2、MAP均升高,HR均降低(P均<0.05),且观察组PaO2/FiO2、MAP高于对照组,HR低于对照组(P<0.05);两组PCT、WBC、CRP水平均降低(P均<0.05),且观察组PCT、WBC、CRP水平低于对照组(P<0.05)。观察组不良反应发生率(8.82%,3/34)与对照组(16.67%,5/30)比较,差异未见统计学意义(P>0.05)。观察组1年存活率(91.17%,31/34)高于对照组(70.00%,19/30),P<0.05。结论CRRT治疗肾功能衰竭并ADHF的效果显著,可提高肾功能和心功能,维持血流动力学稳定,降低炎症因子水平,改善预后。
Objective To analyze the feasibility of continuous renal replacement therapy(CRRT)in salvage therapy for renal failure complicated by acute decompensated heart failure(ADHF).Methods The clinical data of 64 patients with renal failure complicated by ADHF who were admitted to Puyang People’s Hospital from January 2019 to June 2021 were retrospectively analyzed.According to treatment method,they were divided into control group(30 cases)and observation group(34 cases).The control group was treated by intermittent hemodialysis,while the observation group was treated by CRRT.The clinical efficacy,renal function indexes including serum creatinine(Scr),urea nitrogen(BUN)and cystatin C(CysC),cardiac function indexes including left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume index(LVEDVI)and left ventricular end-systolic volume index(LVESVI),hemodynamic indexes including ratio of partial pressure of oxygen in arterial blood to fraction of inspired oxygen(PaO2/FiO2),mean arterial pressure(MAP)and heart rate(HR),inflammatory indexes including procalcitonin(PCT),white blood cell count(WBC)and C-reactive protein(CRP),adverse reaction rate and 1-year survival rate of the two groups were compared.Results The effective rate of the observation group(94.12%,32/34)was higher than that of the control group(70.00%,21/30),P<0.05.After treatment,the levels of Scr,BUN and CysC in the two groups decreased(all P<0.05),and the levels of Scr,BUN and CysC in the observation group were lower than those in the control group(all P<0.05);the levels of LVEF in both groups increased,while LVEDVI and LVESVI decreased(all P<0.05),however,LVEF in the observation group was higher than that in the control group,and LVEDVI and LVESVI were lower than those in the control group(P<0.05).After treatment,the levels of PaO2/FiO2 and MAP in both groups increased,and HR decreased(all P<0.05),moreover,PaO2/FiO2 and MAP in the observation group were higher than those in the control group,while HR was lower than that in the control group(P<0.05).The levels of PCT,WBC and CRP in the two groups decreased after treatment(all P<0.05),and the levels of PCT,WBC and CRP in the observation group were lower than those in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the observation group(8.82%,3/34)and the control group(16.67%,5/30),P>0.05.The 1-year survival rate of the observation group(91.17%,31/34)was higher than that of the control group(70.00%,19/30),P<0.05.Conclusions CRRT has a significant clinical effect in the treatment of renal failure complicated by ADHF,which can improve renal function and cardiac function,maintain hemodynamic stability,reduce levels of inflammatory factors,and improve prognosis.
作者
刘亚敏
王建伟
吕建华
Liu Yamin;Wang Jianwei;Lyu Jianhua(Department of Intensive Care Unit,Puyang People's Hospital,Puyang 457000,China;Department of Pharmacy,Puyang People's Hospital,Puyang 457000,China)
出处
《中国实用医刊》
2023年第4期62-66,共5页
Chinese Journal of Practical Medicine
