急诊腹膜透析在慢性肾心综合征合并难治性充血性心力衰竭患者中的应用

Application of emergency peritioneal dialysis in chronic renocardiac syndrome complicated with refractory congestive heart failure

目的探讨急诊腹膜透析在治疗慢性肾心综合征（chronic renocardic syndrome，CRCS）合并难治性充血性心力衰竭（refractory congestive heart failure，RCHF）患者中的有效性及安全性。方法回顾性分析2014年7月至2015年8月间在随州市中心医院确诊为CRCS合并RCHF患者12例，其中男71例，年龄范围45-72岁，平均年龄（67．7±17．6）岁；女性5例，年龄范围43~69岁，平均年龄（66．8±16．4）岁。12例患者在抗心衰治疗基础上行急诊腹膜透析，比较透析治疗前、后患者临床症状、心功能和肾功能指标的变化，并观察急诊腹膜透析的并发症。结果①所有患者治疗7d后，心衰症状全部缓解；②治疗后患者平均动脉压、心率、B型脑利钠肽、肌酐、尿素氮、血钾均显著降低（P〈0．05）；③治疗后患者左心室射血分数、二氧化碳结合力均明显升高（P〈0．05）；④1例患者腹透液渗漏，3例患者引流不畅，无腹膜炎、出血、脏器损伤及置管处感染等严重并发症发生。结论常规抗心衰治疗基础上急诊床旁腹膜透析能明显改善CRCS合并RCHF患者心、肾功能，操作简单，不良反应少，值得临床推广及应用。在没有血液透析或者连续性肾脏替代治疗时，可以首先使用急诊床旁腹膜透析治疗CRCS合并RCHF患者。

Objective To investigate the effectiveness and safety of emergency peritoneal dialysis in the treatment of chronic renocardiac syndrome（CRCS） patients complicated with refractory congestive heart failure（RCHF）. Methods Patients with chronic kidney disease, whose estimated glomerular filtration rate（eOFR） was less than 30 ml·min^-1·（1.73 m^2）^-1 and symptoms of heart failure （heart function Ⅲ-Ⅳ level, based on New York Heart Disease Association） could not be improved or worsened after regular anti-heart failure treatment（the treatment of rational diuretic, blood vessel expansion agent and digoxin）, were diagnosed as CRCS complicated with RCHF. Twelve patients with such disease were enrolled in Suizhou Central Hospital from July 2014 to August 2015. On the basis of anti-heart failure treatment, emergency peritoneal dialysis treatment was performed. The changes of clinical symptoms, cardiac function and renal function were compared before and after the treatment, and the complications of emergency peritoneal dialysis were observed as well. Results （1）Heart failure symptoms of all patients were relieved after treatment for 7 days. （2）The mean arterial pressure, heart rate, type B brain natriuretic peptide, serum creatinine, blood urea nitrogen, and serum potassium were decreased significantly after treatment （P〈0. 05）; （3）The left ventricular ejection fraction and carbon dioxide binding rate were significantly increased after treatment （P〈0. 05）; （4）In this study, there was 1 case of peritoneal dialysate leakage amd 3 cases of inadequate drainage, and there were no cases of peritonitis, bleeding, organ damage, incubating place infection and other serious complications. Conclusions The emergency peritoneal dialysis based on conventional anti-heart failure treatment can significantly improve the heart and kidney function in patients with CRCS complicated with RCHF, and it is simple operation, has less adverse reactions, and is worth clinical promotion and application. In the absence of hemodialysis or CRRT, we can first use emergency peritoneal dialysis treating patients with CRCS complicated with RCHF.