连续性肾脏替代治疗对心力衰竭合并利尿剂抵抗的治疗效果

Effects of CRRT on patients with heart failure and diuretic resistance

目的观察连续性肾脏替代治疗（CRRT）对慢性心力衰竭急性加重合并利尿剂抵抗患者的治疗效果。方法回顾性分析62例慢性心力衰竭急性加重合并利尿剂抵抗患者给予CRRT治疗前后的病情转归情况、心功能分级（NYHA分级）以及CRRT治疗对心房脑钠肽（BNP）水平、心率（HR）、血肌酐（Cr）水平、左室射血分数（LVEF）等的影响。分析并发利尿剂抵抗的易患因素，观察CRRT治疗的安全性及临床疗效。结果经CRRT治疗，5例患者于超滤治疗期间死亡，57例患者经CRRT治疗后NYHA分级达Ⅱ-Ⅲ级，其中46例痊愈出院，11例进行规律血液透析治疗，治疗总有效率达91.9%。治疗后患者BNP水平较治疗前明显下降，差异有统计学意义（P〈0.01）；而心率、LVEF值治疗前后比较，差异未见统计学意义（P〉0.05）；治疗后患者尿量较治疗前明显增加，差异有统计学意义（P〈0.01）；血尿素氮（BUN）、肌酐（Cr）、血尿酸（UA）水平较治疗前明显下降，差异有统计学意义（P〈0.01）。结论慢性心力衰竭合并轻中度肾功能不全及右心衰竭患者更易发生利尿剂抵抗；感染和缺血是发生心力衰竭加重并发利尿剂抵抗的重要诱因，应及时给予干预；CRRT应用于心力衰竭并利尿剂抵抗患者临床疗效显著，且安全可靠。

ObjectiveTo observe the clinical effects of continuous renal replacement therapy （CRRT） on patients with acute exacerbation of chronic heart failure and diuretic resistance.MethodsOutcome and cardiac function classification （NYHA grading） of 62 patients with acute exacerbation of chronic heart failure and diuretic resistance after CRRT were retrospectively analyzed. The influence of CRRT on atrial natriuretic peptide （BNP） level, heart rate （HR）, serum creatinine （Cr） level and left ventricular ejection fraction （LVEF） were analyzed, too. Assessed the risk factors of concurrent diuretic resistance, observed the safety and clinical efficacy of CRRT.ResultsAfter CRRT treatment, 5 patients died during ultrafiltration treatment, 57 patients reached NYHA Ⅱ to Ⅲ grade, of which 46 cases were cured and discharged, 11 cases were treated by regular hemodialysis, the total effective rate was 91.9%. After treatment, the level of BNP decreased and urinary output increased significantly compared with those before treatment, and the difference was statistically significant （P〈0.01）; however, there was no significant difference in heart rate and LVEF before and afte treatment （P〉0.05）. The levels of blood urea nitrogen （BUN）, creatinine （Cr） and serum uric acid （UA） were significantly decreased compared with those before treatment, the difference was statistically significant （P〈0.01）.ConclusionsDiuretic resistance is more common in patients with chronic heart failure complicated by mild to moderate renal insufficiency and right heart failure. Infection and ischemia are important inducements of worsening heart failure and diuretic resistance, and timely intervention should be given. CRRT is effective and safe for patients with heart failure and diuretic resistance.