连续肾脏替代治疗肾功能衰竭合并急性失代偿性心力衰竭临床研究

Clinical assessment of CRRT as a rescue therapy for patients with chronic renal failure combined with acute decompensated heart failure

目的评估连续肾脏替代治疗(CRRT)在肾功能衰竭(CRF)合并急性失代偿性充血性心力衰竭(ADHF)患者中挽救治疗的效果。方法回顾性收集2010年1月至2015年12月同济大学附属第十人民医院肾功能衰竭患者因急性心功能衰竭无法耐受普通血液透析治疗,而改用CRRT治疗的左室射血分数减少患者的临床资料。主要的研究终点为30 d内患者全因死亡率、180 d内患者全因再住院率及因心力衰竭加重导致再住院的比例,并进一步通过Logistic回归分析评估30 d内导致患者死亡的危险因素。结果研究共纳入了17例患者,在CRRT挽救治疗的患者中,30 d内全因死亡率及心血管事件死亡率为23.5%(4/17)、17.6%(3/17);在存活患者当中,180 d内全因再住院率为53.8%(7/13),因心力衰竭加重而导致的再住院率为23.1%(3/13);与存活患者相比,30 d内死亡患者收缩压更低(P=0.001)。结论肾衰合并ADHF患者CRRT挽救治疗后仍有较高的病死率,且存活患者再住院率明显偏高,治疗起始时低收缩压患者病死率更高。

Objective To evaluate the clinical effect of CRRT as a rescue therapy for CRF patients with ADHF. Methods We retrospectively reviewed the clinical data of 17 consecutive CRF patients who were hospitalized and accepted the CRRT in our hospital from January 2010 to December 2015 due to ADHF with reduced left ventricular ejection fraction （LVEF）. the primary outcome was 30-day all-cause mortaliTY, 180-day all-cause re-hospitalization rate and the proportion of re-hospitalization due to worsening of HF. Mulfivariable Logistic regression was used to evaluate the possible risk factors related to 30-day all-cause mortality. Results Totally 17 consecutive patients were enrolled in this retrospective study. In the patients treated by CRRT, the 30-day all-cause mortality and cardiovascular death rate were 23.5%（4/17）and 17.6%（3/17）; in the patients who were alive, 180-day all-cause re-hospitalization rate and the proportion of re-hospitalization due to worsening of HF were 53.8%（7/13）and 23.1%（3/13）. The patients who were dead within 30 days had a lower systolic blood pressure （P=0.001）. Conclusion The rescue therapy for CRF patients with ADHF still has a high 30-day mortality, and the 180-day re-hospitalization rate was pretty high. The death rate is higher in patients with lower systolic blood pressure at th beginning of treatment.