CRRT联合药物治疗对急性失代偿性心力衰竭预后的影响

Effects of CRRT combined with drugs in patients with acute decompensated heart failure

目的:探讨连续性肾脏替代治疗(CRRT)联合药物对于急性失代偿性心力衰竭(ADHF)患者预后的影响。方法:回顾性研究2015-01-2018-07期间在我院急诊科住院治疗的ADHF患者101例。根据是否接受CRRT治疗,分为CRRT+常规药物治疗组45例(以下简称CRRT组)及常规药物治疗组(以下简称药物治疗组)56例。对两组全因28 d死亡率、住院期间总液体净出量、出院时NT-proBNP水平以及住院费用进行比较,并记录治疗期间不良反应发生情况。同时对所有入组患者出院后随访120 d,记录患者出院后首次心衰事件发生时间,并统计30、60、120 d心衰事件发生率。结果:和药物治疗组相比,CRRT组出院后发生首次心衰事件中位时间更久(78 d vs.38 d,P=0.029),出院后30、60 d心衰事件发生率更低(7.5%vs.23.1%,P=0.045;12.5%vs.34.6%,P=0.015),住院期间总液体净出量更多[(13.10±9.70)L vs.(9.25±5.08)L,P=0.038],治疗过程中新发电解质紊乱更少(8.9%vs.26.8%,P=0.022)。两组28 d全因死亡率差异无统计学意义(13.3%vs.7.1%,P=0.301),出院时NT-proBNP水平与基线值差异相似(-6933.55±12843.09 vs.-6726.69±17413.01,P=0.953)。结论:CRRT能够显著改善ADHF患者循环容量过负荷,减少心衰事件的发生,同时对电解质的影响较小。

Objective:To investigate the effects of CRRT combined with drugs in patients with acute decompensated heart failure(ADHF).Method:A retrospective analysis was performed on 101 patients with acute decompensated heart failure who were hospitalized in the emergency department of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2015 to September 2018.According to whether received CRRT treatment,45 patients were divided into CRRT+conventional drug-treated group and 56 patients were divided into in conventional drug-treated group.The 28-days mortality,total net fluid output during hospitalization,the NT-proBNP level at discharge,and the hospitalization cost were compared between the two groups,and the occurrence of adverse reactions during the treatment period was recorded.At the same time,all patients enrolled were followed up for 120 days after discharge,and the time of first heart failure event after discharge was recorded and the incidence of heart failure events at 30 days,60 days,and 120 days was counted.Result:Compared with the conventional drug-treated group,the CRRT+conventional drug-treated group had a longer median time of first heart failure event within 120 days after discharge(78 days vs.38 days,P=0.029),less incidence of heart failure events at 30 days,60 days(7.5%vs.23.1%,P=0.045;12.5%vs.34.6%,P=0.015)and more total net fluid output during hospitalization[(13.10±9.70)L vs.(9.25±5.08)L,P=0.038].The rate of new electrolyte disorder during treatment was significantly lower(8.9%vs.26.8%,P=0.022).There was no significant difference in 28-day mortality between the two groups(13.3%vs.7.1%,P=0.301),as well as the difference of NT-proBNP level at discharge and baseline(-6933.55±12843.09 vs.-6726.69±17413.01,P=0.953).Conclusion:CRRT can significantly improve the circulatory volume overload in ADHF patients,and it is associated with a prolonged clinical stabilization and a greater freedom from rehospitalization for heart failure with less effect on electrolytes.