终末期肾病并发急性左心衰应用序贯透析联合BiPAP治疗的临床研究

Clinical Effect of Sequential Dialysis Combined with BiPAP on Patients with End-stage Renal Disease Complicated with Acute Left Heart Failure

目的：观察序贯透析（SD）联合双水平气道正压通气（Bi PAP）治疗终末期肾病（ESRD）并发急性左心衰的可行性,以期为ESRD并发急性左心衰的患者提供新的、经济的、安全的治疗思路和方法。方法：选择2013年1月~2014年10月在东莞市清溪医院住院的ESRD并发急性左心衰患者60例为研究对象,随机分成：SD联合Bi PAP治疗观察组和连续肾脏替代疗法（CRRT）对照组,每组30例。比较两组肾功能相关临床指标、血气分析指标以及临床疗效。结果：治疗后两组血尿素氮（BUN）、血肌酐（Scr）肾功能指标,钾（K＋）、钙（Ca^2＋）、磷（P^3-）均出现显著减低（P〈0.05和P〈0.01）,两组对上述指标的减低作用差异无统计学意义（P〉0.05）。治疗后两组氧分压（PaO2）、二氧化碳分压（Pa CO2）均得到显著改善（P〈0.05和P〈0.01）,但观察组的改善作用优于对照组（P〈0.05）。对照组透析时间为（64.32±12.96）h,显著高于观察组的（51.36±7.92）h,P〈0.05。观察组的临床治疗有效率为96.7%（29/30）,对照组为93.3%（28/30）,两组之间差异无统计学意义（P〉0.05）。对照组所用费用约为（9 274.5±814.6）元,显著高于观察组的（7 116.2±658.4）元,P〈0.01。结论：SD联合Bi PAP治疗ESRD并发急性左心衰临床疗效与CRRT治疗差异无统计学意义,但联合治疗对于患者缺氧的纠正作用优于CRRT治疗,而且联合治疗操作简单,费用大幅减低,有利于基层医院的推广使用。

Objective： To observe the effect of sequential dialysis （SD） combined with BiPAP on patients with end - stage renal disease （ESRD） complicated with acute left heart failure. Methods：60 cases of ESRD patients complicated with acute left heart failure were enrolled in this study. All the patients were divided into： SD combined with BiPAP observation group（ n = 30） and CRRT control group （ n = 30）. The renal function indexes, blood gas analysis index and clinical effect were compared between the two groups. Results：After treatment, the BUN, Scr, K^＋ , Ca^2＋ , and p3- was decreased in the two groups （P 〈0.05 and P 〈0.01 ）. There was no significant difference of above index decreases between the two groups （P 〉 0.05 ）. After treatment, PaO2 and PaCO2 was improved in the two groups （P 〉 0.05）. However, the changes was better in observation group than that in control group （ P 〈 0.05 ）. The dialysis time in control group was （64.32 ± 12.96 ） h, which was significantly higher than that of （51.36 ± 7.92） h in observation group （P 〈 0.05 ）. The clinical effective rate was 96.7% （29/30） in observation group and 93.3% （28/30） in control group. There was no significant difference between the two groups （P 〉 0.05）： The expense was （9274.5 ± 814.6） yuan in control group, which was higher than that of （7 116.2 ± 658.4） yuan in observation group （P 〈 0.01 ）. Conclusion ： The clinical effect of SD combined with BiPAP in the treatment of ESRD complicated with acute left heart failure had no significant difference with CRRT treatment. But the combined therapy was better in treating patients with hypoxia, and greatly reduce the cost.