Ⅰ型心肾综合征的临床进展

Clinical Progress of Type Ⅰ Heart and Kidney Syndrome

心肾综合征(CRS)是指心脏或肾脏中单个器官对另一器官的功能损害不能进行代偿,从而引发恶性循环,最终导致患者心脏与肾功能均出现不同程度的损伤。参考该病原发病部位可将其分为5个类型,包括Ⅰ型:急性心肾综合征;Ⅱ型:慢性心肾综合征;Ⅲ型:急性肾心综合征;Ⅳ型:慢性肾心综合征;Ⅴ型:继发性心肾综合征。其中,Ⅰ型急性心肾综合征患者在发病初期心功能可在短时间内恶化,同时伴随有急性肾损伤。急性心力衰竭及极具恶化的充血性心力衰竭可能导致心脏排血量较大程度降低,引起肾动脉灌注不足,静脉压力增加,肾小球滤过率降低,最终引发患者出现急性急性肾损伤。在针对Ⅰ型急性心肾综合征患者临床治疗时,长时间、大剂量利尿剂的使用,造影剂的使用均可能导致急性肾损伤出现;同时血管紧张素转化酶抑制剂的使用可能对肾小球滤过率产生一定的降低作用,最终诱发心肾综合征出现。早期的准确诊断,并结合患者自身情况开展合理的治疗方案一直是心肾综合征临床治疗的关键。笔者就该疾病的发病机制、临床症状表现及具体治疗方案的选择做一综述,旨在为Ⅰ型心肾综合征患者后续治疗及相应的防治工作提供参考。

Cardio-renal syndrome（CRS） refers to the inability of a single organ in the heart or kidney to compensate for the functional impairment of another organ,thereby triggering a vicious cycle that eventually leads to varying degrees of impairment in both heart and kidney function.According to the location of the pathogen,it can be divided into five types,including type Ⅰ：acute cardio-renal syndrome;type Ⅱ：chronic cardio-renal syndrome;type Ⅲ：acute renal-heart syndrome;type Ⅳ：chronic renal-heart syndrome;type Ⅴ：secondary cardiopulmonary syndrome.Among them,in patients with type Ⅰ acute cardiopulmonary syndrome,heart function can be deteriorated in a short period of time at the onset of the disease,accompanied by acute kidney injury.Acute heart failure and deteriorating congestive heart failure may lead to a greater reduction in cardiac output,resulting in insufficient renal artery perfusion,increased venous pressure,decreased glomerular filtration rate,and eventually acute acute kidney injury.In the clinical treatment of patients with type Ⅰ acute cardio-renal syndrome,the use of long-term,high-dose diuretics and the use of contrast agents may lead to the occurrence of acute kidney injury;while the use of angiotensin-converting enzyme inhibitors may be on the kidney The filtration rate of the ball produces a certain reduction,which eventually induces the appearance of cardiac and renal syndrome.Early and accurate diagnosis,combined with the patient＇s own situation to develop a reasonable treatment program has been the key to the clinical treatment of cardio-renal syndrome.The author made a review of the pathogenesis of the disease,the clinical symptoms and the choice of specific treatment plans,aiming to provide reference for follow-up treatment and corresponding prevention and treatment of type Ⅰ patients with cardio-renal syndrome.