早期缬沙坦降血压治疗对老年继发性慢性肾脏病患者肾脏替代效果的影响

Effect of early valsartan on renal replacement in elderly patients with secondary chronic kidney disease

目的观察早期缬沙坦降血压治疗对老年继发性慢性肾脏病患者肾脏替代临床效果的影响。方法选择2015年10月—2017年10月安徽医科大学附属巢湖医院肾内科诊治的老年慢性肾脏病合并肾性高血压患者90例作为研究对象,按照随机数字表法分观察组、对照组,每组45例。对照组进行肾脏替代疗法,观察组早期给予缬沙坦降压治疗,然后进行肾脏替代疗法,治疗4周后观察2组患者的心率及血压变化、肾脏功能以及不良反应等。结果治疗前2组患者的心率及血压、血生化、肾功能、电解质比较差异均无统计学意义(P>0.05),治疗后心率、收缩压(SBP)、舒张压(DBP)、中心静脉压(CVP)均低于治疗前,且观察组改善优于对照组(t/P=5.854/0.000、8.965/0.000、6.412/0.000、9.134/0.000);治疗后2组患者的血清肌酐(SCr)、血尿素氮(BUN)以及24 h尿蛋白定量较治疗前均显著下降,肾小球滤过率(GFR)较治疗前显著上升,且观察组改善较对照组显著(t/P=5.924/0.000、5.438/0.000、3.748/0.000、8.690/0.000);治疗后2组患者的血钾、血钠、血氯、碳酸氢盐均较治疗前升高,且观察组较对照组升高更显著(t/P=4.602/0.000、2.313/0.023、4.528/0.000、5.384/0.000);观察组的不良反应发生率为6.67%低于对照组22.22%(χ~2/P=4.410/0.037)。结论早期缬沙坦降血压的效果较好,使肾脏替代疗法的效果提高,明显改善血生化、血流动力学、肾功能,并且不良反应较少,在临床上可广泛使用。

Objective To observe the effect of early valsartan on renal replacement in elderly patients with secondary chronic kidney disease.Methods From October 2015 to October 2017,90 elderly patients with chronic kidney disease and renal hypertension were selected as the study subjects.According to the random number table method,the observation group and the control group were divided into 45 cases in each group.The control group was treated with renal replacement therapy,while the observation group was treated with valsartan at the early stage,followed by renal replacement therapy.After 4 weeks of treatment,the heart rate,blood pressure,renal function and adverse reactions were observed in the two groups.Results There was no significant difference in heart rate,blood pressure,blood biochemistry,renal function and electrolyte between the two groups before treatment(P>0.05).After treatment,heart rates,systolic blood pressure(SBP),diastolic blood pressure(DBP),central venous pressure(CVP)were lower than before treatment,and the improvement of the observation group was better than that of the control group(t/P=5.854/0.000,t/P=8.965/0.000,t/P=6.412/0.000,9.134/0.000).After treatment,the serum creatinine(SCr),blood urea nitrogen(BUN)and 24-hour urinary protein in both groups decreased significantly,glomerular filtration rate(GFR)increased significantly,and the improvement in the observation group was more significant than that in the control group(t/P=5.924/0.000,t/P=5.438/0.000,t/P=3.748/0.000,t/P=8.690/0.000).Sodium,blood chlorine and bicarbonate were all increased in the observation group(t/P=4.602/0.000,t/P=2.313/0.023,t/P=4.528/0.000,t/P=5.384/0.000),and the incidence of adverse reactions in the observation group was 6.67%lower than that in the control group(22.22%)(χ^2/P=4.410/0.037).Conclusion Early valsartan has better effect in lowering blood pressure,increasing the effect of renal replacement therapy,improving blood biochemistry,hemodynamics,renal function,and less adverse reactions.It can be widely used in clinic.