持续性肾脏替代治疗难治性心衰疗效的影响因素分析

Analysis of the Influencing Factors of Curative Effect of Continuous Renal Replacement Therapy for Refractory Heart Failure

目的:探讨持续性肾脏替代(CRRT)治疗难治性心衰疗效的影响因素。方法:回顾性分析住院诊断为难治性心力衰竭、接受CRRT治疗的患者45例。按治疗效果分为治疗有效组25例,无效组20例,比较两组患者间疾病构成比例、血压、心脏射血分数以及电解质、肾肝功能。结果:(1)本组资料中CRRT治疗难治性心衰的有效率为55.6%;(2)扩张型心肌病和缺血性心肌病总比例,无效组明显高于治疗有效组(80%vs32%,P<0.01);(3)与治疗有效组比较,无效组患者的收缩压、舒张压和心脏射血分数明显低下[(145.5±30.5vs126.5±23.5)mmHg,(85.4±23.6vs68.5±20.6)mmHg,(33.0±5.33)%vs(29.6±4.26)%];各项指标比较均P<0.05。结论:CRRT可用于治疗难治性心力衰竭,但对于扩张型心肌病和缺血性心肌病引起的心肌收缩力下降导致血压偏低、心脏射血分数明显低下者,疗效不佳。

Objective：To investigate the influencing factors of curative effect to continuous renal replacement therapy（CR-RT） for treatment of refractory heart failure. Methods：Retrospective 45 patients who had been diagnosed as refractory heart failure and received CRR＇F were analyzed in our hospital. They were divided into 2 groups according to treatment effectiveness： 25 of the effective group, 20 of the inefficient group. The constituent ratio of diseases, blood pressure, cardiac ejection fraction and electrolyte, renal and hepatic function were compared between the groups. Results： （1）The effective power of CRRT for treatment of refractory heart failure was 55.6% according to the data; （2）the con- proportion of patients with dilated cardiomyopathy or ischaemic cardiomyopathy in the inefficient group was obviously higher than that in effective group（80 % vs 32 %, P 〈 0.01 ） ; （3） compared with the effective group, systolic pressure, diastolic pressure and cardiac ejection fraction of patients in the inefficient group were obviously lower（ 145.5 ± 30.5 vs 126.5 ± 23.5）mmHg, （85.4 ± 23.6 vs 68.5 ±20.6）mmHg, [ （33.0± 5.33） % vs 29.6± 4.26） % ] ;There were statistic differences among each index. Conclusion： CRRT could be used to treat refractory heart failure, but it does not have a fine effect for low blood pressure and low cardiac ejection fraction resulting from the descent of myocardial contractility caused by dilated cardiomyopathy and ischaemic cardiomyopathy.