持续肾替代治疗改善急性心肌梗死合并心肾功能不全患者PCI术后心肾功能和预后的作用

Effect of continuous renal replacement therapy on improving cardiac and renal function and prognosis of patients with acute myocardial infarction complicated with cardiac and renal insufficiency after PCI

目的探究持续肾替代治疗(CRRT)改善急性心肌梗死合并心肾功能不全患者经皮冠状动脉介入治疗(PCI)术后心肾功能和预后的作用。方法回顾性分析2016年3月-2018年10月在扬中市人民医院及牡丹江医学院附属二院接受PCI治疗的96例急性心肌梗死合并心肾功能不全患者的资料。其中对照组40例PCI术后常规静脉水化治疗,观察组56例PCI治疗前后均行CRRT。观察PCI术前、PCI术后24、48和72 h,两组患者血肌酐(Scr)、尿素氮(BUN)、肾小球滤过率(eGFR)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、氨基末端脑钠肽前体(NT-proBNP)、C反应蛋白(CRP)水平;观察两组对比剂肾病(CIN)发生率。结果PCI术后24h,观察组Scr、BUN、NGAL、NT-proBNP、CRP水平较PCI术前下降(P<0.05);对照组Scr水平比术前增加45μmol/L左右;两组eGFR水平较PCI术前上调,观察组上调幅度更显著(P<0.05).PCI术后48、72 h,观察组Scr、BUN、NGAL、NT-proBNP、CRP水平显著下降(P<0.05),eGFR水平显著上升(P<0.05);对照组Scr、BUN、NGAL、NT-proBNP、CRP水平较PCI术后24 h显著下降,eGFR水平显著上升(P<0.05)。观察组APACHEⅡ评分、CIN发生率显著低于对照组,差异均有统计学意义(P<0.05)。结论CRRT能够明显改善急性心肌梗死合并心肾功能不全患者PCI术后的心肾功能,减少CIN的发生,从而有利于患者PCI术后恢复。

Objective To explore the effect of continuous renal replacement therapy on improving cardiac and renal function and prognosis of patients with acute myocardial infarction complicated with cardiac and renal insufficiency after PCI.Methods A retrospective analysis was made on 96 patients with acute myocardial infarction complicated with cardiac and renal insufficiency who received PCI treatment in Yangzhong People's Hospital and the second Affiliated Hospital of Mudanjiang Medical College from March 2016 to October 2018.40 patients were divided into control group according to different treatment methods.Patients were only treated with intravenous hydration after PCI.56 patients in the observation group were treated with CRRT before and after PCI.The levels of serum creatinine(Scr),urea nitrogen(BUN),glomerular filtration rate(eGER),neutrophil gelatinase-associated lipocalin(NGAL),amino-terminal brain natriuretic peptide precursor(NT-proBNP)and C-reactive protein(CRP)were observed before PCI,24 hours after PCI and 48 hours after PCI.The incidence of contrast nephropathy(CIN)in the two groups was observed.Results 24 hours after PCI,the levels of Scr,BUN,NGAL,NT-proBNP and CRP in the observation group were lower than those before PCI(P<0.05).The Scr level of patients in the control group increased by 45p,mol/L compared with that before PCI,and the eG-FR level of patients in the two groups was up-regulated compared with that before PCI,and the up-regulation range in the observation group was more significant(P<0.05).The levels of Scr,BUN,NGAL,NT-proBNP and CRP in the observation group decreased significantly at 48,721i after PCI(P<0.05).The eGFR level of patients in the observation group increased significantly at 48,72 h after PCI(P<0.05).At 48,72 h after PCI,the levels of Scr,BUN,NGAL,NT-proBNP and CRP in the control group were significantly lower than those at 24 h after PCI,and the levels of eGFR were significantly higher(P<0.05).APACHE Ⅱ score and CIN incidence in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusion CRRT can obviously improve the cardiac and renal functions of patients with acute myocardial infarction complicated with cardiac and renal insufficiency after PCI and reduce the occurrence of CIN,thus being beneficial to the recovery of patients after PCI.