不同时间的连续性肾脏替代治疗终末期肾衰竭伴急性心肌梗死患者的临床效果对比

Comparison of CRRT clinical effect of different times in treating patients with end-stage renal failure companied with acute myocardial infarction

目的:探究与分析不同时间的连续性肾脏替代治疗(CRRT)终末期肾衰竭伴急性心肌梗死患者的临床效果。方法:选取医院收治的102例终末期肾衰竭合并急性心肌梗死患者的临床资料,按照不同CRRT时间将每日治疗时间8~12 h患者纳入日间组(66例),每日治疗时间20~24 h患者纳入24 h组(36例),对比两组患者治疗前后急性生理与慢性健康评价Ⅱ(APACHEⅡ)评分、有效性指标[血肌酐值、钾离子、血红蛋白(Hb)、白蛋白(ALb)]变化、血流动力学稳定性指标、日均脱水量、治疗费用和住院时间;治疗后随访3个月,对比分析两组不良事件中出血事件、低血压事件及死亡事件的发生率。结果:治疗后日间组患者的血肌酐值、钾离子均低于24 h组,APACHEⅡ评分高于24 h组,其差异有统计学意义(t=2.006,t=7.521,t=2.064;P<0.05)。两组治疗后Hb、ALb、血管加压药指数(VI)、血管加压药依赖性百分比(VD%)、透析前VI最高值与透析期间VI最高值之间的差值(ΔVI)及透析前VD最高值与透析期间VD最高值之间的差值(ΔVD%)相比,差异均无统计学意义。日间组日均脱水量、治疗费用均低于24 h组、住院时间少于24 h组,差异有统计学意义(t=3.931,t=7.445,t=3.730;P<0.05)。两组治疗后随访3个月的出血事件发生率、低血压事件发生率以及死亡事件发生率相比,差异无统计学意义。结论:日间CRRT治疗可获得更好的治疗效果,促进维持血流动力学的稳定性,并可缩短住院时间,减少治疗费用,但短期预后表现尚无明显优势。

Objective:To explore and analyze the clinical effects of continuous renal replacement therapy(CRRT)of different times in patients with end-stage renal failure companied with acute myocardial infarction.Methods:Clinical data of 102 patients with end-stage renal failure complicated with acute myocardial infarction who admitted to hospital were selected.According to different CRRT times,patients with daily treatment duration of 8-12 h were included in the daytime group(66 cases),and those with daily treatment duration of 20-24 h were included in the 24 h group(36 cases).The changes of the effectiveness indexes[blood creatinine value,potassium ion,hemoglobin(Hb),albumin(ALb)],the indicator of hemodynamic stability,the daily average dehydration,treatment cost,the hospital stay before and after treatment were compared between the two groups.The incidences of bleeding event,hypotension event and death event of adverse events between the two groups were compared and analyzed in the 3 months of follow-up after treatment.Results:After treatment,the serum creatinine value and potassium ion concentration in the daytime group were significantly lower than those in the 24 h group,and the acute physiology and chronic health evaluationⅡ(APACHEⅡ)score was significantly higher than that in the 24 h group,and the differences were statistically significant(t=2.006,t=7.521,t=2.064,P<0.05).The differences of the hemoglobin(Hb),albumin(Alb),vasopressor index(VI),vasopressor dependence percentage(VD%),the difference between the highest VI value before dialysis and the highest VI value during dialysis(ΔVI),and the difference between the highest VD value before dialysis and the highest VD value during dialysis(ΔVD%)between the two groups were not statistically significant.The daily average dehydration and treatment cost in the daytime group were lower than those in the 24 h group,and the hospital stay was less than 24 h group,with statistical significance(t=3.931,t=7.445,t=3.730,P<0.05).In the 3 months of follow-up after treatment,there were no significant differences in the incidences of bleeding event,hypotension event and death event between the two groups.Conclusion:Daytime CRRT therapy can achieve better therapeutic effect,and promote the maintenance for hemodynamic stability,and shorten hospital stay and reduce treatment costs,but there is no obvious advantage in short-term prognosis.