重组人脑利尿钠肽联合艾考糊精透析液序贯治疗腹膜透析合并慢性心力衰竭急性发作的疗效

Efficacy of recombinant human brain natriuretic peptide combined with icodextrin dialysate in sequential treatment of peritoneal dialysis complicated with acute attack of chronic heart failure

目的探讨重组人脑利尿钠肽(rhBNP)联合艾考糊精透析液序贯治疗腹膜透析(PD)合并慢性心力衰竭急性发作(ACHF)的疗效。方法PD合并ACHF患者45例,随机分为观察组(18例)和对照组(27例)。两组均给予rhBNP治疗72 h;对照组同时采用2.5%葡萄糖透析液,观察组在停止rhBNP后序贯7.5%艾考糊精透析液。治疗7 d后比较两组临床疗效、心脏结构和功能、透析充分性指标变化,观察患者近期预后,记录两组患者不良反应发生情况。结果观察组临床总有效率高于对照组(94.44%vs.66.67%),再次住院率低于对照组(5.56%vs.29.63%)(P<0.05)。治疗后,两组左心室射血分数(LVEF)、心脏指数较治疗前升高,且观察组高于对照组(P<0.05)。治疗后,两组左心室舒张末期内径(LVEDd)、SCr和BUN较治疗前降低,且观察组低于对照组(P<0.05)。观察组LVEF提升≥10%、LVEF提升≥50%、LVEDd缩小≥5 mm和LVEDd缩小≥10 mm的患者比例均高于对照组(P<0.05)。治疗后,两组尿素清除指数(Kt/V)、残肾Kt/V、内生肌酐清除率(Ccr)和残肾Ccr较治疗前升高,且观察组高于对照组(P<0.05)。两组不良反应发生率相仿(P>0.05)。结论rhBNP联合艾考糊精透析液序贯治疗PD合并ACHF临床疗效显著,可改善心脏结构和功能,提高透析充分性,降低再次住院率,且安全性高。

Objective To investigate the efficacy of recombinant human brain natriuretic peptide(rhBNP)combined with icodextrin dialysate in sequential treatment of peritoneal dialysis(PD)complicated with acute attack of chronic heart failure(ACHF).Methods A total of 45PD patients complicated with ACHF were randomly divided into two groups.The patients of both groups were treated with rhBNP for 72hours.Group A(27cases)received 2.5%glucose dialysate at the same time and group B(18cases)was given 7.5%icodextrin dialysate after stopping rhBNP.The clinical efficacy,cardiac structure and function,and dialysis adequacy indexes were compared between the two groups 7days after treatment.The short-term prognosis of the patients was observed.The occurrence of adverse reactions was recorded.Results The total effective rate was higher in group B than that in group A(94.44%vs.66.67%),while re-hospitalization rate was lower in group B than that in group A(5.56%vs.29.63%)(P<0.05).The left ventricular ejection fraction(LVEF)and cardiac index were higher after treatment than those before in two groups,which were higher in group B than those in group A after treatment(P<0.05).The left ventricular end-diastolic diameter(LVEDd),SCr and BUN of the two groups were lower after treatment than those before,which were lower in group B than those in group A after treatment(P<0.05).The proportions of the patients with LVEF increase≥10%,LVEF increase≥50%,LVEDd decrease≥5mm and LVEDd decrease≥10mm were higher in group B than those in group A(P<0.05).The Kt/V,residual kidney Kt/V,Ccr and residual kidney Ccr of the two groups were higher after treatment than those before,which were higher in group B than those in group A after treatment(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion rhBNP combined with icodextrin dialysate in sequential treatment of PD patients complicated with ACHF has remarkable clinical efficacy,which can improve cardiac structure and function,elevate dialysis adequacy,decrease the rate of re-hospitalization,and has high safety.