连续性血液净化治疗Ⅰ型心肾综合征患者的疗效分析

Effect of continuous blood purification in the treatment of cardiorenal syndrome type Ⅰ

目的探讨连续性血液净化治疗（CBP）对Ⅰ型心肾综合征（CRS）的临床疗效。方法收集2012年1月至2014年6月武汉市中心医院重症医学科42例使用CBP治疗Ⅰ型CRS患者的临床资料，记录患者CBP治疗前及治疗5d后平均动脉压、心率、呼吸频率、急性生理与慢性健康状况评分Ⅱ（APACHEⅡ）、尿量的变化；同步观察患者的肾功能监测指标、心功能监测指标的变化；治疗过程中使用PICCOplus监测患者心指数、胸腔内血容积指数、全心舒张末期容积指数、中心静脉压、血管外肺水指数等指标变化；比较患者治疗前后左心室射血分数变化。结果42例Ⅰ型CRS患者在CBP治疗过程中循环稳定，平均动脉压差异无统计学意义（P=0．08）。治疗5d后，其心动过速、呼吸急促症状较治疗前缓解（均P〈0．05），尿量增加、APACHEⅡ评分下降（均P〈0．05）；同时治疗前后患者的肌酐（413．6±126．1）gmol／L比（126．8±68．3）μmol／L、血清胱抑素C（4．1±1．1）g／L．比（1．1±0．8）g／L，肌钙蛋白（3．5±0．7）μg／L比（2．6±0．4）μg／L、B型利钠多肽（3300．3±567．6）ng／L比（807．6±427．7）ng／I。（均P〈0．05）。CBP治疗后患者心肌收缩力、容量前负荷、肺相关参数均改善（P〈0．05）。结论CBP治疗能缓解Ⅰ型CRS患者的临床症状，改善心、肾功能。

Objective To evaluate the effect of continuous blood purification （CBP） on eardiorenal syndrome （CRS） type Cardiorenal syndrome; Hemofi ltrationⅠMethods Clinical data of 42 patients with CRS type Cardiorenal syndrome; Hemofi ltration at our hospital were collected from January 2012 to June 2014. We observed and compared changes in mean arterial pressure （MAP）, heart rate, respiration rate, acute physiology and chronic health evaluation （APACHE） Ⅱ score, and urinary volume before and 5 days after CBP. Meanwhile, levels of serum creatinine （Scr）, cysteine proteinase inhibitor Cystatin C （CysC）, serum creatinine （cTn） and B-type natriuretic peptid （BNP） were monitored. In addition, dynamic changes in cardiac index （CI）, intrathoracic blood volume index （ITBI）, global end-diastolic volume index （GEDI）, central venous pressure （CVP）, and extravaseular lung water index （ELVWI） were monitored using the pulse induced contour cardic output plus monitoring system （PiCCO plus）, and changes in left ventricular ejection fraction （LVEF） before and 5 days after CBP was measured by color Doppler ultrasound. Results There was no significant difference in MAP in patients with CRS type I before and 5 days after CBP （P=0.08）. Tachycardia and tachypnea improved, while urine volume increased and the APACHE H score decreased significantly, 5 days after CBP（allP〈0.05）. Plasma levels of Scr, CysC, eTn and BNP after treatment were lower than those before treatment [（126.8± 68.3） μmol/L vs （413.6±126.1） μmol/L, （1.1±40.8） g/L vs. （4.1±1.1） g/L, （2.6±0.4） μg/L vs. （3.54± 0.7）μg/L, （807.6±427.7） ng/L vs （3300.3 567.6） ng/L, all P〈0.05）]. Myocardial contractility , cardiac preload and lung related parameters also significantly improved after CBP （allP 〈0.05）. Conclusions CBP can alleviate clinical symptoms of CRS type I, improve cardiac and renal function, and is promising as an important auxiliary measure for the treatment of patients with cardiorenal syndrome typeCardiorenal syndrome; Hemofi ltration.