CRRT联合左卡尼汀治疗慢性肾衰竭合并急性心力衰竭的疗效分析

Therapeutic efficacy of CRRT combined with levocarnitine in chronic renal failure with acute heart failure

目的分析连续性肾脏替代治疗(CRRT)联合左卡尼汀治疗慢性肾衰竭合并急性心力衰竭的疗效。方法选取2017年4月—2020年4月解放军总医院第六医学中心收治的慢性肾衰竭合并急性心力衰竭患者104例,根据随机数字表法分成对照组和试验组。其中对照组使用常规治疗联合左卡尼汀,试验组在对照组的基础上给予CRRT治疗。比较两组血氧指标、心功能指标、肾功能相关指标和血清鸢尾素、sST2、IL-33等水平。结果两组患者治疗前PO_(2)、PCO_(2)、LVESD、LVEDD、LVEF、BUN、Scr、BNP,血清鸢尾素、sST2、IL-33水平比较,差异无统计学意义(P>0.05)。试验组总有效率高于对照组(P<0.05)。试验组治疗前后PO_(2)的差值大于对照组(P<0.05),PCO_(2)的差值小于对照组(P<0.05)。试验组治疗前后LVESD、LVEDD的差值小于对照组(P<0.05),LVEF的差值大于对照组(P<0.05)。试验组治疗前后BUN、Scr和BNP的差值小于对照组(P<0.05)。试验组治疗前后血清鸢尾素、sST2、IL-33的差值大于对照组(P<0.05)。结论CRRT联合左卡尼汀治疗慢性肾衰竭合并急性心力衰竭具有较好的临床疗效,可改善患者的心功能和肾功能,值得临床推广。

Objective To analyze the efficacy of continuous renal replacement therapy(CRRT)combined with levocarnitine in the treatment of chronic renal failure complicated with acute heart failure.Methods A total of 104 patients with chronic renal failure complicated with acute heart failure admitted to our hospital from April 2017 to April 2020 were selected and divided into control group and experimental group according to random number table method.The control group received conventional treatment combined with levocarnitine,while the experimental group was additionally treated with CRRT.Blood oxygen,cardiac function,renal function,and serum levels of irisin,soluble growth stimulation expressed gene 2(sST2),and interleukin-33(IL-33)were compared between the two groups.Results Before the treatment,there was no difference in partial pressure of oxygen(PO_(2)),partial pressure of carbon dioxide(PCO_(2)),left ventricular end-systolic dimension(LVESD),left ventricular enddiastolic dimension(LVEDD),left ventricular ejection fraction(LVEF),blood urea nitrogen(BUN),serum creatinine(Scr),B-type natriuretic peptide(BNP),serum irisin,sST2 or IL-33 levels between the groups(P>0.05).The overall effective rate of the experimental group was higher than that of the control group(P<0.05).The difference of PO_(2) before and after the treatment was higher(P<0.05),but that of PCO_(2) before and after the treatment was lower in experimental group compared with control group(P<0.05).The differences of LVESD and LVEDD before and after the treatment in experimental group were lower than those in control group(P<0.05),while the difference of LVEF before and after the treatment in experimental group was higher than that in control group(P<0.05).The differences of BUN,Scr,and BNP before and after treatment were lower(P<0.05),whereas those of serum irisin,sST2 and IL-33 levels before and after treatment were higher in experimental group in comparison to control group(P<0.05).Conclusions CRRT combined with levocarnitine in the treatment of chronic renal failure with acute heart failure has good clinical efficacy,and can improve the cardiac and renal functions of patients.Thus,it is worthy of being more widely adopted in the clinical practice.