左西孟旦联合连续性肾替代治疗对心源性休克合并急性肾损伤患者预后的影响

Effect of levosimendan combined with continuous renal replacement therapy on the prognosis of patients with cardiogenic shock complicated with acute kidney injury

目的探讨左西孟旦联合连续性肾替代治疗对心源性休克合并急性肾损伤患者预后的影响。方法本研究为病例对照研究,选取2020年1月至2022年1月运城第一医院心内科收治的60例急性心肌梗死后心源性休克合并急性肾损伤患者,男38例,女22例,年龄(62.93±7.35)岁,年龄范围为51~76岁。根据治疗方案不同将患者分为左西孟旦组与连续性肾替代治疗组,每组30例。比较两组患者肾功能、心功能、血流动力学的变化及预后的具体情况。结果治疗前两组患者肾功能指标比较,差异无统计学意义(P>0.05)。治疗后两组患者血肌酐清除率[(43.66±6.19)ml/min、(36.53±6.06)ml/min]均高于治疗前[(21.76±6.78)ml/min、(22.02±6.94)ml/min],尿素氮[(11.49±3.52)mmol/L、(15.71±3.48)mmol/L]、血肌酐[(313.57±96.51)mmol/L、(421.83±91.76)mmol/L]水平均低于治疗前[(21.43±5.36)mmol/L、(21.37±5.29)mmol/L,(572.46±123.36)mmol/L、(564.74±125.45)mmol/L],且左西孟旦组患者血肌酐清除率高于连续性肾替代治疗组,尿素氮、血肌酐水平均低于连续性肾替代治疗组,差异有统计学意义(P<0.05)。治疗前两组患者心功能指标比较,差异无统计学意义(P>0.05)。治疗后两组患者左心室射血分数[LVEF,(43.68±5.25)%、(36.28±5.42)%]均高于治疗前[(30.35±3.45)%、(30.81±3.53)%],左心室舒张期末容积[LVEDD,(48.46±5.33)mm、(54.75±5.49)mm]均低于治疗前[(60.47±6.53)mm、(60.36±6.64)mm],且左西孟旦组LVEF高于连续性肾替代治疗组,LVEDD低于连续性肾替代治疗组,差异有统计学意义(P<0.05)。治疗前两组患者血流动力学指标比较,差异无统计学意义(P>0.05)。治疗后两组患者平均动脉压[MAP,(79.36±6.35)mmHg、(71.64±6.22)mmHg,1 mmHg=0.133 kPa]均高于治疗前[(57.72±5.54)mmHg、(57.85±5.61)mmHg],中心静脉压[CVP,(9.58±1.27)cmH_(2)O、(11.46±1.53)cmH_(2)O,1 cmH_(2)O=0.098 kPa]、心率[(101.56±6.64)次/分、(112.47±6.35)次/分]均低于治疗前[(14.54±2.41)cmH_(2)O、(14.66±2.39)cmH_(2)O,(122.07±8.91)次、(121.84±8.67)次],且左西孟旦组MAP高于连续性肾脏替代治疗组,CVP、心率均低于连续性肾替代治疗组,差异有统计学意义(P<0.05)。治疗前两组患者急性生理学—慢性健康状况评分Ⅱ(APACHEⅡ)评分比较,差异无统计学意义(P>0.05)。治疗后两组患者APACHEⅡ评分[(23.47±6.63)分、(31.38±6.48)分]均低于治疗前[(45.86±5.65)分、(45.94±5.46)分],且左西孟旦组APACHEⅡ评分低于连续性肾替代治疗组,差异有统计学意义(P<0.05)。结论左西孟旦联合连续性肾替代治疗能有效改善心源性休克合并急性肾损伤患者的肾功能、心功能,维持血流动力学稳定,改善预后,值得推广。

Objective To investigate the effect of levosimendan combined with continuous renal replacement therapy on the prognosis of patients with cardiogenic shock and acute kidney injury.Methods This study was a case-control study.From January 2020 to January 2022,a total of 60 patients with cardiogenic shock combined with acute renal injury after acute myocardial infarction,including 38 males and 22 females,aged(62.93±7.35)years old,aged from 51 to 76 years old,were selected from the department of Cardiology,Yuncheng First Hospital.According to different treatment schemes,they were divided into levosimendan group and continuous renal replacement treatment group,with 30 cases in each group.The changes of renal function,cardiac function,hemodynamics and prognosis of the two groups were compared.Results There was no significant difference in renal function between the two groups before treatment(P>0.05).After treatment,the serum creatinine clearance rate[(43.66±6.19)ml/min,(36.53±6.06)ml/min]in both groups were higher than that before treatment[(21.76±6.78)ml/min,(22.02±6.94)ml/min],urea nitrogen[(11.49±3.52)mmol/L,(15.71±3.48)mmol/L]The levels of serum creatinine[(313.57±96.51)mmol/L,(421.83±91.76)mmol/L]were lower than those before treatment[(21.43±5.36)mmol/L,(21.37±5.29)mmol/L,(572.46±123.36)mmol/L,(564.74±125.45)mmol/L],and the clearance rate of serum creatinine in patients in the levosimendan group was higher than that in the continuous renal replacement treatment group,and the levels of urea nitrogen and serum creatinine were lower than that in the continuous renal replacement treatment group,the differences were statistically significant(P<0.05).There was no significant difference in cardiac function between the two groups before treatment(P>0.05).After treatment,left ventricular ejection fraction[LVEF,(43.68±5.25)%,(36.28±5.42)%]of patients in the two groups were higher than those before treatment[(30.35±3.45)%,(30.81±3.53)%],left ventricular end diastolic volume[LVEDD,(48.46±5.33)mm,(54.75±5.49)mm]were lower than those before treatment[(60.47±6.53)mm,(60.36±6.64)mm],and LVEF in the levosimendan group was higher than that in the continuous renal replacement treatment group,LVEDD was lower than that in the continuous renal replacement treatment group,the differences were statistically significant(P<0.05).There was no significant difference in hemodynamic indexes between the two groups before treatment(P>0.05).After treatment,mean arterial pressure[MAP,(79.36±6.35)mmHg,(71.64±6.22)mmHg,1 mmHg=0.133 kPa]in both groups were higher than those before treatment[(57.72±5.54)mmHg,(57.85±5.61)mmHg],central venous-pressure[CVP,(9.58±1.27)cmH_(2)O,(11.46±1.53)cmH_(2)O,1 cmH_(2)O=0.098 kPa]The heart rate per minute[(101.56±6.64)times,(112.47±6.35)times]was lower than that before treatment[(14.54±2.41)cmH_(2)O,(14.66±2.39)cmH_(2)O,(122.07±8.91)times,(121.84±8.67)times],and the MAP of the levosimendan group was higher than that of the continuous renal replacement treatment group,and the CVP and heart rate were lower than that of the continuous renal replacement treatment group,the differences were statistically significant(P<0.05).There was no significant difference in acute physiology and chronic health evaluationⅡ(APACHEⅡ)score between the two groups before treatment(P>0.05).After treatment,the APACHEⅡscore of patients in the two groups[(23.47±6.63)points,(31.38±6.48)points]were lower than those before treatment[(45.86±5.65)points,(45.94±5.46)points],and the APACHEⅡscore of patients in the levosimendan group was lower than that in the continuous renal replacement treatment group,the differences were statistically significant(P<0.05).Conclusions Levosimendan combined with continuous renal replacement therapy can effectively improve renal function and cardiac function,maintain hemodynamic stability and improve prognosis in patients with cardiogenic shock complicated with acute kidney injury.It is worth popularizing.