持续性肾脏替代治疗难治性心衰患者的临床效果及对血肌酐值、B型利钠肽的影响

Clinical Effect of Continuous Renal Replacement Therapy in Patients with Refractory Heart Failure and Its Effect on Serum Creatinine and B-type Natriuretic Peptide

目的:探讨持续性肾脏替代治疗(CRRT)难治性心衰患者的临床效果及对血肌酐值、B型利钠肽的影响.方法:选取2016年7月-2019年6月本院收治的难治性心衰患者85例,将其随机分为对照组(43例)和研究组(42例).对照组采用常规治疗,研究组在常规治疗的基础上联合应用持续性肾脏替代治疗.比较两组治疗前后的氧合指数(OI)、心率(HR)、心排血量(CO)、肺毛细血管楔嵌压(PCWP)及右房压(RAP)、血肌酐(Scr)、N末端B型利钠肽原(NT-proBNP)、心功能相关指标水平.结果:治疗后,两组的CO、OI水平均升高,且研究组的CO、OI水平均高于对照组,差异均有统计学意义(P<0.05).治疗后,两组的RAP、PCWR及HR水平均降低,且研究组的RAP、PCWR及HR水平均低于对照组,差异均有统计学意义(P<0.05).治疗后,研究组的Scr、NT-proBNP、LVEDVI及LVESVI水平均显著低于对照组,LVEF水平显著高于对照组,差异均有统计学意义(P<0.05).结论:在常规治疗基础上联合应用持续性肾脏替代治疗,可显著改善难治性心衰患者的心功能指标水平,降低患者的Scr值及NT-proBNP水平.

Objective:To explore the clinical effect of continuous renal replacement therapy(CRRT)in patients with refractory heart failure and its effect on serum creatinine and B-type natriuretic peptide.Method:Eighty-five patients with refractory heart failure admitted to our hospital from July 2016 to June 2019 were selected.They were randomly divided into control group(43 cases)and study group(42 cases).The control group received conventional treatment,the study group applied continuous renal replacement therapy on the basis of conventional treatment.Oxygenation index(OI),heart rate(HR),cardiac output(CO),pulmonary capillary wedge pressure(PCWP),right atrial pressure(RAP),serum creatinine(Scr),N-terminal B-type natriuretic peptide(NT-proBNP),and cardiac function were compared between the two groups before and after treatment.Result:After treatment,the levels of CO and OI in both groups were increased,the levels of CO and OI in the study group were higher than those in the control group,with statistically significant differences(P<0.05).After treatment,the RAP,PCWR and HR levels in both groups were decreased,the RAP,PCWR and HR levels in the study group were lower than those in the control group,with statistically significant differences(P<0.05).After treatment,the level of Scr,NT-proBNP,LVEDVI and LVESVI in the study group were significantly lower than those in the control group,the level of LVEF was significantly higher than that in the control group,with statistically significant differences(P<0.05).Conclusion:Combined application of continuous renal replacement therapy on the basis of conventional treatment can significantly improve the level of cardiac function indicators in patients with refractory heart failure,reduce the Scr value and NT-proBNP level in patients.