早期持续性肾脏替代对心力衰竭合并急性肾损伤的干预效果

Effect of early continuous renal replacement therapy for heart failure associated with acute renal injury

目的探讨早期持续性肾脏替代治疗在心力衰竭合并急性肾损伤(AKI)中的应用价值。方法选择80例心力衰竭合并AKI患者为研究对象,随机分为观察组(n=40)与对照组(n=40),均接受连续性血液净化治疗,其中观察组早期应用,对照组则晚期应用,比较两组治疗前后Scr、BNP、CRP以及APACHEⅡ评分、MAP、HR的变化,记录两组入住ICU时间及28 d病死率。结果治疗后,两组患者Scr、BNP、CRP及APACHEⅡ评分较治疗前显著下降,且观察组低于对照组,差异有统计学意义(P<0.05);治疗后,两组患者MAP显著升高,HR显著降低,差异有统计学意义(P<0.05);观察组住ICU时间明显短于对照组,差异有统计学意义(P<0.05);两组患者病死率比较,差异无统计学意义(P>0.05)。结论早期应用持续性肾脏替代技术对心力衰竭合并急性肾损伤患者进行干预,可有效降低血清炎症因子水平、改善心功能及肾功能,促进疾病的恢复、缩短入住ICU时间。

Objective To explore the value of early continuous renal replacement therapy for heart failure associated with acute renal injury（AKI）. Methods The 80 cases of heart failure with AKI were enrolled as the research object and randomly divided into observation group（n=40） and control group（n=40）,then were treated with continuous blood purification treatment,the observation group were early given CRT,meanwhile the control group latter did so,then both group＇s Scr,BNP,CRP and APACHE score,MAP,HR,ICU hospitalization time were compared with before and after treatment,and the 28 d mortality rate was recorded. Results After treatment,Scr,BNP,CRPand APACHE score in both groups decreased significantly,and the observation group were lower than the control group,the difference was statistically significant（P〈0.05）;after treatment,MAP significantly increased,HR decreased significantly in two groups,the difference was statistically significant（P〈0.05）;ICU stay time in the observation group was shorter than the control group（P〈0.05）;the mortality rate was compared between the two groups,there was no statistically significant difference（P〈0.05）. Conclusion Early application of CBP for the patients with heart failure complicated with AKI can effectively reduce their serum inflammatory factors,improve cardiac function and renal function,promote disease recovery and shorten ICU stay time.