单硝酸异山梨酯注射液联合连续性肾脏替代疗法治疗尿毒症慢性心力衰竭的疗效评价

Effects of isosorbide mononitrate injection combined with continuous renal replacement therapy in patients with uremia congestive heart failure

目的探讨单硝酸异山梨酯注射液联合连续性肾脏替代疗法(CRRT)治疗尿毒症慢性心力衰竭(CHF)的疗效及对患者肾功能指标、心功能指标及血清甲状旁腺素(PTH)、N末端B型脑钠肽(NT-proBNP)水平的影响。方法前瞻性选取2020年5月至2022年5月在邵阳学院附属第一医院治疗的120例尿毒症CHF患者作为研究对象,采用随机数字表法分为CRRT组和联合组,每组60例,分别采用CRRT治疗和单硝酸异山梨酯联合CRRT治疗,两组均治疗1周,比较两组治疗后临床总有效率、肾功能指标、心功能指标、血清PTH、NT-proBNP水平及不良反应发生情况。结果联合组总有效率高于CRRT组[98.33%(59/60)比85.00%(51/60)],差异有统计学意义(χ^(2)=5.35,P<0.05)。联合组治疗1周后血肌酐、尿素氮、β2微球蛋白水平低于CRRT组[(670.83±81.80)μmol/L比(706.88±93.27)μmol/L、(10.62±2.58)mmol/L比(12.80±3.55)mmol/L、(13.16±2.98)mg/L比(16.00±2.84)mg/L],差异有统计学意义(P<0.05)。联合组治疗1周后左室收缩末期内径、左室舒张末期内径低于CRRT组,左室射血分数高于CRRT组[(42.88±4.16)mm比(46.37±6.55)mm、(51.57±8.33)mm比(56.42±7.55)mm、(49.50±6.27)%比(44.68±5.14)%],差异有统计学意义(P<0.05)。联合组治疗1周后血清PTH、NT-proBNP水平低于CRRT组[(50.16±7.15)ng/L比(53.27±6.46)ng/L、281.52(255.46,304.50)mmol/L比362.49(331.88,378.42)mmol/L],差异有统计学意义(P<0.05)。两组不良反应发生率比较差异无统计学意义(P>0.05)。结论单硝酸异山梨酯联合CRRT对于改善尿毒症CHF患者心肾功能、减轻心脏负荷具有良好效果。

Objective:To explore the effects of isosorbide mononitrate injection combined with continuous renal replacement therapy(CRRT)in patients with uremia congestive heart failure(CHF)and the effects on renal function,cardiac function,and serum parathyroid hormone(PTH),and N terminal pro-B-type natriuretic peptide(NT-proBNP)levels.Methods:A total of 120 CHF patients with uremia who were treated in the First Affiliated Hospital of Shaoyang University from May 2020 to May 2022 were selected as the research objects,and they were divided into the CRRT group and the combined group by the random number table method,with 60 cases in each group.They were treated with CRRT and isosorbide mononitrate combined with CRRT,respectively.After treatment for 1 week,the total effective rate,renal function,cardiac function,serum PTH,NT-proBNP and adverse reactions of the two groups were compared.Results:After treatment for 1 week,the total effective rate in the combined group was higher than that in the CRRT group:98.33%(59/60)vs.85.00%(51/60),there was statistical diffenrence(χ^(2)=5.35,P<0.05).After treatment for 1 week,the levels of serum creatinine,blood urea nitrogen andβ2 microglobulin-MG in the combined group were lower than those in the CRRT group:(670.83±81.80)μmol/L vs.(706.88±93.27)μmol/L,(10.62±2.58)mmol/L vs.(12.80±3.55)mmol/L,(13.16±2.98)mg/L vs.(16.00±2.84)mg/L,there were statistical differences(P<0.05).After treatment for 1 week,the left ventricular end systolic diameter and left ventricular end diastolic diameter were lower than those in the CRRT group,and left ventricular ejection fraction was higher than that in the CRRT group:(42.88±4.16)mm vs.(46.37±6.55)mm,(51.57±8.33)mm vs.(56.42±7.55)mm,(49.50±6.27)%vs.(44.68±5.14)%,there were statistical differences(P<0.05).After treatment for 1 week,the levels of PTH and NT-proBNP in the combined group were lower than those in the CRRT group:(50.16±7.15)ng/L vs.(53.27±6.46)ng/L,281.52(255.46,304.50)mmol/L vs.362.49(331.88,378.42)mmol/L,there were statistical differences(P<0.05).There was no statistical difference in adverse reactions between the two groups(P>0.05).Conclusions:Isosorbide mononitrate combined with CRRT has a good effect on improving cardiac and renal function and reducing cardiac load in patients with uremia CHF.