缓慢连续性血液透析治疗老年心肺功能衰竭的疗效

Therapeutic effect of continuous hemodialysis therapy on aged patients with heart and lung failure

目的:观察连续性血液透析治疗对老年心肺功能衰竭患者的疗效。方法:174例老年心肺功能衰竭患者被分血液透析组(96例)和常规治疗组(78例),记录机械通气参数及呼吸机支持力度(正压),测定动脉血气,评估肺功能情况,以脉搏指示连续心输出量监测(PiCCO)心输出量(CO)、心指数(CI)、血管外肺水(EVLWI)、心率(HR)评估血流动力学,测定血浆脑型利钠肽(BNP)含量评估心功能,结果:与治疗前相比,血液透析组动脉血气氧分压[(65.32±5.35)mmHg比(101.43±5.87)mmHg]显著提高(P<0.05),肺泡—动脉氧分压差[(39.38±3.61)mmHg比(7.53±3.54)mmHg]显著下降(P<0.01)。与常规治疗组治疗后比较,血液透析组血流动力学CO[(1.87±0.14)L·min-1·m-2比(4.59±0.37)L·min-1·m-2]、CI[(1.45±0.24)比(4.68±0.75)]显著升高,EVLWI[(9.89±0.74)ml/kg比(5.67±0.21)ml/kg],BNP[(13283.98±173.91)pg/ml比(4584.26±94.71)pg/ml]显著降低(P均<0.01)。结论:缓慢、连续性血液透析可有效治疗老年心肺功能衰竭,可能与清除炎症介质、缓慢脱水减轻心脏肺负担等有关。

Objective：To observe the therapeutic effect of continuous hemodialysis therapy on aged patients with heart and lung failure.Methods：A total of 174 aged patients with heart and lung failure were divided into hemodialysis group （n =96） and routine treatment group （n =78）.Mechanical ventilation parameters and ventilator support （positive pressure） were recorded,arterial blood gas was measured,pulmonary function was evaluated,cardiac output （CO）,cardiac index （CI）,extravascular lung water index （EVLWI） and heart rate （HR） were monitored by pulse-indicated continuous cardiac output （PiCCO） in order to evaluate hemodynamic change,and plasma brain natriuretic peptide （BNP） level was measured to evaluate cardiac function.Results：Compared with before treatment,there was significant increase in arterial oxygen tension [（65.32 ± 5.35） mmHg vs.（101.43 ± 5.87） mmHg,P〈0.05],significant decrease in alveolar-arterial oxygen difference [（39.38 ± 3.61） mmHg vs.（7.53 ± 3.54） mmHg,P〈0.01] in hemodialysis group.Compared with routine treatment group after treatment,there were significant increase in CO [（1.87± 0.14） L · min-1 · m-2 vs.（4.59± 0.37） L · min-1 · m-2] and CI [（1.45 ± 0.24） vs.（4.68± 0.75）],and significant decrease in EVLWI [（9.89 ± 0.74） ml/kg vs.（5.67± 0.21） ml/kg] and BNP [（13283.98± 173.91） pg/ml vs.（4584.26± 94.71） pg/ml] in hemodialysis group,P〈0.01 all.Conclusion：Continuous hemodialysis can be effective in treating aged patients with heart and lung failure,which may be related to clearing inflammatory mediator and relieving heart and lung burden via slow dehydration etc.