肾脏替代治疗对肾功能不全并重症肺炎患者的心脏保护作用

Cardiac protection effect of CRRT in patients with chronic renal failure complicated severe pneumonia

目的:观察连续性肾脏替代治疗(CRRT)液体管理对慢性肾功能不全(CRF)并重症肺炎患者心功能的保护作用。方法:137例CRF并重症肺炎患者被分为液体管理组(73例)和常规治疗组(64例),以CRRT强化脱水行液体管理,以脉搏指示连续心输出量(PiCCO)监测仪监测心输出量(CO)、心脏指数(CI)、血管外肺水指数(EVLWI)指导液体管理;测定支气管清洗液中肺组织白介素-6(IL-6)及血浆脑利钠肽(BNP),血浆降钙素原(PCT)浓度;并测定动脉血氧分压(PaO2)及肺泡—动脉氧分压差(P(A-a)O2)。结果:治疗1周后,与常规治疗组相比,液体管理组血BNP[(3283.8±73.9)pg/ml比(1884.6±64.1)pg/ml]、肺IL-6[(197.5±11.2)pg/ml比(146.8±10.2)pg/ml]水平,EVLWI[(7.89±0.74)ml/kg比(5.67±0.21)ml/kg],血PCT[(1.29±0.18)pg/ml比(0.88±0.06)pg/ml],P(A-a)O2[(15.38±3.61)mmHg比(7.53±3.54)mmHg]明显下降(P<0.05或<0.01);CO[(3.87±0.14)L.min-1.m-2比(4.59±0.37)L.min-1.m-2]、CI[(3.45±0.24)比(4.68±0.75)]、PaO2[(85.32±14.35)mmHg比(101.43±5.87)mmHg]明显提高(P<0.05或<0.01)。结论:连续性肾脏替代治疗液体管理可改善慢性肾功能不全并重症肺炎患者的心肺功能。

Objective： To observe effect protecting cardiac function of fluid management by continuous renal replace- ment therapy （CRRT） in patients with chronic renal failure （CRF） complicated severe pneumonia. Methods： A to- tal of 137 CRF cases with severe pneumonia were divided into fluid management group （n = 73） and routine treat- ment group （n = 64）. CRRT strengthened dehydration was used to perform liquid management and pulse-indicated continuous cardiac output （PiCCO） monitor was used to monitoring cardiac output （CO）, cardiac index （CI） and extravascular lung water index （EVLWI） to guide fluid management in fluid management group. Interleukin -6 （IL- 6） concentration in cleaning solution of bronchi was measured. Plasma brain natriuretic peptide （BNP） and procalci- tonin （PCT） were measured. Arterial blood oxygen pressure （PaO2） and alveolar - arterial oxygen difference （P （A -a） O2） were measured. Results： Compared with routine treatment group one week after treatment, there were significant decrease in levels of BNP [ （3283.8 ± 73.9） pg/ml vs. （1884.6 ± 64.1） pg/ml], lung tissue IL-6 [ （197.5±11.2） pg/ml vs. （146.8 ± 10.2） pg/ml], EVLWI [ （7.89 ±0.74） ml/kg vs. （5.67 ± 0.21） ml/kg], PCT [ （1.29±0.18） pg/mlvs. （0.88±0.06）pg/ml] andP （A-a） O2 [-（15.38±3.61） mmHgvs. （7.53±3.54） mmHg], P 〈0.05 or 〈0.01] and significant increase in CO [ （3.87 ± 0.14） L min^-1 m^-2 vs. （4.59 ± 0.37） L min-1 m-2], CI [ （3.45 ± 0.24） vs. （4.68 ± 0.75）1 and PaO2 [ （85.32± 14. 35） mmHg vs. （101.43 ± 5.87） mmHg] in liquid man- agement group, P〈0.05 or 〈0.01. Conclusion： Continuous renal replacement therapy fluid management combined with PiCCO monitoring can improve cardiopulmonary function in patients with chronic renal failure complicated se- vere pneumonia.