连续肾脏替代治疗对急性非ST段抬高型心肌梗死并心肾功能不全患者的疗效及预后分析

Analysis on the Efficacy and Prognosis of Continuous Renal Replacement Therapy in Patients with Acute Non-ST-Segment Elevation Myocardial Infarction Complicated with Heart and Kidney Dysfunction

目的观察合并心力衰竭、肾功能不全的急性非ST段抬高型心肌梗死(NSTEMI)患者给予连续性肾脏替代治疗(CRRT)的疗效及预后情况。方法选择2013年6月至2015年12月我院收治的急性NSTEMI并心肾功能不全患者83例,其中后CRRT组为PCI后行CRRT共37例,前-后CRRT组为PCI前后均行CRRT共35例,对照组为水化及药物治疗共11例。对比三组患者入院时、治疗24 h后和治疗48 h的肌酐浓度、GFR、NGAL、Apelin水平,对患者进行随访,评估患者的不良心血管事件发生率。结果前-后CRRT组的肾功能指标显著优于对照组和后CRRT组,差异有统计学意义(P<0.05)。前-后CRRT组的MACE发生率显著低于对照组和后CRRT组,差异有统计学意义(P<0.05)。结论心肾功能不全的急性NSTEMI患者在术前及术后均行CRRT能有效改善其肾功能水平,且预后情况较好,具有较高的临床应用价值。

Objective To observe the efficacy and prognosis of continuous renal replacement therapy （CRRT） in patients with acute non-ST-elevation myocardial infarction （NSTEMI） complicated with heart failure and renal insufficiency. Methods A total of 83 patients with acute NSTEMI complicated with heart and kidney dysfunction admitted to our hospital from June 2013 to December 2015 were selected. 37 patients in the post-CRRT group were treated with CRRT after PCI, 35 patients in the pre-post-CRRT group were treated with CRRT before and after PCI, and 11 patients in the control group were given hydration and drug treatment. At admission, 24 h of treatment and 48 h of treatment, the creatinine concentrations, and levels of GFR, NGAL and Apelin of three groups were compared. Patients were followed up to assess the incidence of adverse cardiovascular events. Results The renal function indicators of the pre-post-CRRT group were significantly better than those of the control group and the post-CRRT observation group （P 〈0.05）, and the incidence of MACE of the pre-post-CRRT group was significantly lower than that of the control group and the post-CRRT group （P 〈0.05）. Conclusions The application of CRRT before and after surgery in patients with acute NSTEMI complicated with heart failure and renal insufficiency can effectively improve patients＇ renal function, with good prognosis, which has a high clinical application value.