连续性肾脏替代治疗联合主动脉内球囊反搏治疗慢性肾功能不全患者合并心源性休克的疗效分析

Efficacy of CRRT Ccombined with IABP in Ttreatment of Cchronic Nnephritis Ccomplicated with Ccardiogenic Sshock

目的探讨连续性肾脏替代治疗(CRRT)联合主动脉内球囊反搏(IABP)治疗慢性肾功能不全患者合并心源性休克的疗效观察。方法选取2016年3月—2019年7月就诊于乐山市人民医院的慢性肾功能不全患者合并心源性休克60例,全部给予CRRT联合IABP治疗,检测CRRT联合IABP治疗14d前后的血红蛋白、C-反应蛋白、肾功能、电解质、N末端前脑利钠肽及心脏结构和功能的变化。结果与治疗前相比,治疗14 d后患者的血尿素氮(BUN)和血肌酐(SCR)下降,上皮生长因子细胞增殖和信号传导的受体(EGFR)升高,K^+、Na^+、CO2CP趋于正常(P<0.05),肾功能明显改善。治疗14 d后血红蛋白(Hb)明显增高,贫血明显改善,C-反应蛋白(CRP)、NT-proBNP明显下降,心功能明显改善,差异有统计学意义(P<0.05)。治疗14 d后,CI、SV、EF、FS增高,LAD、LVDs、LVDd下降心脏功能明显改善,差异有统计学意义(P<0.05)。结论CRRT联合IABP治疗慢性肾功能不全肾炎患者合并心源性休克,可有效改善患者的心肾功能,稳定血流动力学,调节电解质和酸碱平衡,有效控制炎症以及明显减少传统血液透析的不良反应,具有良好的应用前景。

Objective To investigate the efficacy of continuous renal replacement therapy(CRRT) combined with intra-aortic balloon pump(IABP) in the treatment of chronic kidney disease chronic glomerulonephritis with cardiogenic shock. Methods60 patients with chronic renal function complicated with cardiogenic shock were selected from March, 2016 to July, 2018. All patients were treated with CRRT combined with IABP. The changes of hemoglobin, C-reactive protein, renal function, electrolyte, Nterminal pro-brain natriuretic peptide and cardiac structure and function were detected before and after 14 days of CRRT combined with IABP. Results After 14 days of treatment, BUN and SCR decreased significantly, renal insufficiency decreased, EGFR increased, renal insufficiency improved. K^+, Na^+, and C02 CP tended to normal. There were were significant differences in electrolyte imbalance and acid-base disturbance between the two groups(P<0.05). After 14 days of treatment, hemoglobin(Hb) increased, anemia improved, C-reactive protein(CRP) and NT-proBNP decreased, and cardiac function improved significantly(P<0.05). After 14 days of treatment, LAD, LVDd and LVDs were significantly decreased, CI and SV were significantly increased significantly, EF and FS were significantly increased, and E/A was significantly different. Conclusion These results indicate that after CRRT combined with IABP treatment, atrioventricular diameter decreased significantly, SV and EF increased significantly, and cardiac systolic and diastolic function improved significantly. The difference was statistically significant(P<0.05).Conclusion CRRT combined with IABP in the treatment of chronic kidney disease chronic glomerulonephritis patients with cardiogenic shock can effectively improve cardiac and renal function, stabilize hemodynamics, regulate electrolyte and acid-base balance,effectively control inflammation and significantly reduce adverse reactions of traditional hemodialysis, and. It has a good application prospect.