连续性肾脏替代治疗不同射血分数心力衰竭伴肾功能不全66例

Study of therapeutic effect of continuous renal replacement therapy in heart failure patients with renal dysfunction with different ejection function

目的探讨连续性肾脏替代(CRRT)治疗不同左心室射血分数(LVEF)心力衰竭伴肾功能不全病人的疗效。方法选取2016年12月至2017年12月滁州市第一人民医院心力衰竭伴肾功能不全病人66例,所有病人均在规范内科治疗基础上行CRRT治疗。依据CRRT治疗前的LVEF分为两组,LVEF保留组33例(LVEF≥50%)和LVEF降低组33例(LVEF<50%),对比两组病人的临床疗效及预后。结果(1)两组病人CRRT治疗时间、超滤液体量、CRRT上机次数、治疗模式及住院时间比较,均差异无统计学意义(P>0.05);(2)两组治疗前后平均动脉压(MAP)差异无统计学意义(P>0.05),但两组治疗前后6分钟步行试验、N末端B型利钠肽原(NT?proBNP)、血清C反应蛋白(CRP)、肌酐(Cr)、LVEF比较,差异有统计学意义(P<0.05);(3)LVEF降低组与LVEF保留组治疗前后相关指标的差值比较,CRP的差值[(12.91±3.64)mg/L、(12.28±3.76)mg/L]、Cr的差值[(203.45±73.23)μmol/L、(209.55±62.84)μmol/L]差异无统计学意义(P>0.05),但6分钟步行试验的差值[(-97.09±16.50)m、(-78.73±12.03)m]、NT?proBNP的差值[(2 895.10±784.46)pg/mL、(2 124.68±647.01)pg/mL]、LVEF的差值[(-5.09±368)%、(-1.37±3.61)%]差异有统计学意义(P<0.01);(4)LVEF降低组总有效率为90.91%,LVEF保留组总有效率为87.88%,疗效比较差异无统计学意义(P>0.05);⑸LVEF降低组与LVEF保留组30 d内再住院率(24.24%和33.33%)及全因死亡率(3.03%和6.06%)比较,差异无统计学意义(P>0.05)。结论CRRT可明显改善心力衰竭伴肾功能不全病人的容量过负荷状态,疗效确切,不良反应甚微。LVEF降低病人较LVEF保留病人对CRRT治疗存在更好的治疗反应性,但两者预后无明显差异。

Objective To investigate the effect of continuous renal replacement therapy(CRRT)in heart failure patients with re?nal dysfunction with different ejection fraction.Methods 66 patients with heart failure were selected,all of whom received CRRT treatment on the basis of standardized internal medicine treatment.According to the LVEF before CRRT treatment,there were two groups:33patients in the LVEF retention group(LVEF≥50%)and 33 patients in the LVEF reduction group(LVEF<50%).The clinical efficacy and prognosis of the two groups were compared.Results(1)There were no statistically significant differences in CRRT treatment time,ultrafiltration volume,CRRT visits,treatment modes and hospitalization time between the two groups(P>0.05)(.2)The difference of the MAP in two groups before and after treatment has no statistical significance(P>0.05),however,6 minutes walk test,NT?proBNP,CRP,Cr,LVEFdifferences were statistically significant(P<0.05);(3)The difference between the two groups before and after treatment of relevant indicators value comparison,CRP[(12.91±3.64)mg/L,(12.28±3.76)mg/L],Cr[(203.45±73.23)μmol/L,(209.55±62.84)μmol/L]differential difference no statistical significance(P>0.05),but 6 minutes walking test[(-97.09±16.50)m,(-78.73±12.03)m],NT?proBNP[(2 895.10±784.46)pg/mL,(2 124.68±647.01)pg/mL]and LVEF[(-5.09±368)%,(-1.37±3.61)%]of difference statistically significant difference(P<0.01);(4)The total effective rate inthe LVEF reduction group was 90.91%,and the total effective rate in the LVEF retention group was 87.88%,with no statisticallysignificant difference(P>0.05)(. 5)There was no statistically significant difference in re?hospitalization rate(24.24%,33.33%)andall?cause mortality(3.03%,6.06%)between the two groups within 30 d(P>0.05).Conclusion CRRT can significantly improvethe capacity overload status of patients with heart failurewith renal dysfunction,with definite efficacy and little adverse reactions.Pa?tients with decreased LVEF had better therapeutic response to CRRT than patients with LVEF reservation,but there was no signifi?cant difference in prognosis.