连续性肾脏替代疗法对难治性心力衰竭伴利尿药抵抗患者预后的影响

Effect of Continuous Renal Replacement Therapy on Prognosis of Patients with Refractory Heart Failure and Diuretic Resistance

目的探讨连续性肾脏替代疗法(continuous renal replacement therapy,CRRT)对难治性心力衰竭(refractory heart failure,RHF)伴利尿药抵抗患者预后的影响,分析其影响因素。方法选取北京市普仁医院2019年1月至2022年1月收治的利尿药抵抗性RHF患者102例开展回顾性研究。患者均采用CRRT治疗,比较患者治疗前、后的左心室射血分数(left ventricular ejection fraction,LVEF)、心脏指数(cardiac index,CI)、心排血量(cardiac output,CO),检测血清氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、血肌酐(serum creatinine,Scr)、尿酸(uric acid,UA)、血尿素氮(blood urea nitrogen,BUN)浓度,并记录24 h尿量变化。观察患者28 d的预后情况,根据预后分成生存组、死亡组,收集并比较两组患者的临床资料,利用多元Logistic回归模型分析CRRT治疗患者预后的影响因素。结果经治疗后,患者LVEF、CI、CO高于治疗前,血清NT-proBNP浓度低于治疗前,差异有统计学意义(P<0.05)。患者治疗后的血清Scr、UA、BUN浓度低于治疗前,而24 h尿量高于治疗前,差异有统计学意义(P<0.05)。102例患者中病死率为35.29%,生存率为64.71%。死亡组入院后6 h内治疗占比为13.89%,低于生存组的40.91%,且死亡组入院时平均动脉压(mean arterial pressure,MAP)、血红蛋白(hemoglobin,Hb)浓度及24 h尿量低于生存组,血清NT-proBNP浓度高于生存组,差异有统计学意义(P<0.05)。多元Logistic回归分析显示,患者入院后6 h内接受治疗及入院时相对较高的MAP、Hb浓度及24 h尿量是预后保护性因素,入院时血清NT-proBNP浓度过高是预后危险因素(P<0.05)。结论CRRT对利尿药抵抗性RHF患者有一定治疗作用,但早期病死率仍较高,且CRRT治疗的预后与多种因素相关,临床需引起重视。

Objectives To investigate the effect of continuous renal replacement therapy(CRRT)on the prognosis of patients with refractory heart failure(RHF)and diuretic resistance,and to analyze the influencing factors.Methods A retrospective study was conducted on 102 patients with diuretic-resistant RHF who were treated in Beijing Puren Hospital from January 2019 to January 2022.All the patients were treated with CRRT.The left ventricular ejection fraction(LVEF),cardiac index(CI),cardiac output(CO)were compared before and after treatment.Concentrations of N-terminal probrain natriuretic peptide(NT-proBNP),serum creatinine(Scr),uric acid(UA),blood urea nitrogen(BUN),and the changes in 24 h urine volume were recorded.The 28-day prognosis of the patients was observed,and the patients were divided into survival group and death group according to the prognosis.The clinical data of the two groups were collected and compared,and the multivariate Logistic regression model was used to analyze the influencing factors of the prognosis of patients treated with CRRT.Results After treatment,the LVEF,CI,and CO of the patients were higher than those before treatment,and the serum concentration of NT-proBNP was lower than that before treatment(P<0.05).The serum concentrations of Scr,UA and BUN of the patients after treatment were lower than those before treatment,while the 24 h urine volume was higher than that before treatment(P<0.05).Among the 102 patients,the mortality rate was 35.29%,and the survival rate was 64.71%.The proportion of treatment within 6 hours after admission in death group was 13.89%,which was lower than 40.91%in survival group.The levels of mean arterial pressure(MAP),hemoglobin(Hb)and 24 h urine volume in death group at admission were lower than those in survival group,and the serum concentration of NTproBNP was higher than that in survival group(P<0.05).Multivariate Logistic regression analysis showed that patients receiving treatment within 6 hours after admission and with relatively high levels of MAP,Hb and 24 h urine output were prognostic protective factors,and high serum concentration of NT-proBNP on admission was a prognostic risk factor(P<0.05).Conclusions CRRT has a certain therapeutic effect on diuretic-resistant RHF patients,but the early mortality rate is still high,and the prognosis of CRRT treatment is related to various factors,which should be paid attention to in clinical practice.