4种血液净化方式治疗老年Ⅰ型心肾综合征的疗效评估

发布时间：2018-03-13 09:50

本文选题：老年人　切入点：心肾综合征　出处：《中国全科医学》2015年22期 　论文类型：期刊论文

【摘要】：目的探讨4种不同血液净化方式对老年I型心肾综合征(CRS)的疗效。方法选取2011年2月—2014年8月在大连医科大学附属第二医院心内科及肾内科住院的老年I型CRS患者共198例,根据血液净化治疗方式分为4组,分别为单纯超滤(UF)组41例、缓慢连续超滤(SCUF)组44例、间断血液透析(IHD)组52例、连续性静静脉血液滤过(CVVH)组61例,检测治疗前及首次治疗24 h后的理化指标及评估治疗1周后的心肾功能改善情况。结果治疗前4组患者血清尿素(Urea)、肌酐(SCr)、钾(K)、钠(Na)、B型尿钠肽(BNP)、肌钙蛋白(Tn-I)水平及平均动脉压(MAP)比较,差异均无统计学意义(P0.05)。而治疗后4组患者血清Urea、SCr、K、Na、BNP、Tn-I水平及MAP比较,差异均有统计学意义(P0.05);其中SCUF、IHD、CVVH组血清Urea、SCr、K、Na、BNP、Tn-I水平及MAP与UF组比较,IHD组血清K、BNP水平与SCUF组比较,CVVH组血清Urea、SCr、K、BNP、Tn-I水平与SCUF组比较,CVVH组血清Urea、SCr、BNP、Tn-I水平与IHD组比较,差异均有统计学意义(P0.05)。治疗前4组患者左心室舒张末期内径(LDV)、心输出量(CO)及左心室射血分数(LVEF)、中心静脉压(CVP)比较,差异均无统计学意义(P0.05)。而治疗后4组患者LDV、CO、LVEF、CVP比较,差异均有统计学意义(P0.05);其中SCUF、IHD组LDV、CO、LVEF、CVP与UF组比较,CVVH组LDV、CO、LVEF、CVP分别与UF、SCUF、IHD组比较,差异均有统计学意义(P0.05)。4组患者治疗后心、肾功能改善情况比较,差异均有统计学意义(P0.05);其中CVVH组疗效优于UF、SCUF、IHD组,SCUF、IHD组疗效亦优于UF组,差异均有统计学意义(P0.05)。结论对于老年I型心肾综合征患者,CVVH治疗安全性最佳、疗效最好,SCUF与IHD治疗在安全性及疗效上比较并无差异,UF治疗安全性及疗效一般,不推荐选择。
[Abstract]:Objective to investigate the effect of four different blood purification methods on elderly patients with type I cardiorenal syndrome (CRS). Methods A total of 198 elderly patients with type I CRS were selected from February 2011 to August 2014 in Department of Cardiology and Renal Medicine, second affiliated Hospital of Dalian Medical University. According to the method of blood purification, the patients were divided into 4 groups: 41 cases in simple ultrafiltration group, 44 cases in SCUFU group, 52 cases in IHD group and 61 cases in CVVH group. Physical and chemical indexes were measured before treatment and 24 hours after the first treatment, and the improvement of cardiac and renal function was evaluated after 1 week of treatment. Results the levels of serum urea UreaI, creatinine, potassium carnitine, natriuretic natriuretic peptide type B (BNPN), cardiac troponin Tn-I (Tn-I) were measured before treatment and 24 hours after first treatment. Mean arterial pressure (MAPP), There was no significant difference (P 0.05). After treatment, the levels of Tn-I and MAP in serum of the four groups were compared. There were significant differences between the two groups (P 0.05), among which the levels of Tn-I in serum of MAP group and SCUF group were significantly higher than that of SCUF group and that of SCUF group and that of SCUF group were significantly higher than that of SCUF group and that of SCUF group and that of SCUF group were higher than those of SCUF group and that of SCUF group respectively, and that of SCUF group and SCUF group were higher than that of SCUF group and that of SCUF group and that of SCUF group were significantly higher than that of SCUF group and that of SCUF group and that of SCUF group and that of SCUF group were higher than that of SCUF group and that of SCUF group and that of SCUF group and that of SCUF group and that of SCUF group and SCUF group respectively, and there were significant differences between SCUF group and SCUF group. There was no significant difference in left ventricular end-diastolic diameter (LDV), cardiac output volume (CO), left ventricular ejection fraction (LVEFN) and central venous pressure (CVP) between the four groups before and after treatment (P 0.05), but there was no significant difference in LDVCOLVEFV CVP between the four groups after treatment. The difference was statistically significant (P 0.05), among which there were significant differences in the improvement of heart and kidney function between the patients with SCUFF IHD and the patients with CVVH and UFG SCUFIHD after treatment, and the difference between the CVP of LDVCOCOLVEFN CVP and UF group was statistically significant compared with that of CVVH group and UFG SCUFFIHD group, and there were significant differences in the improvement of heart and kidney function after treatment between SCUFU IHD group and UF group. The difference was statistically significant (P 0.05), and the curative effect of CVVH group was better than that of UF group, and the difference was statistically significant. Conclusion CVVH is the best in the treatment of elderly patients with type I cardiorenal syndrome. There is no difference in safety and efficacy between SCUF and IHD.
【作者单位】：大连医科大学附属第二医院肾内科;大连医科大学临床技能教研室;
【基金】：十二五国家科技支撑计划课题(2011BAI10B08)——血液净化质量改进和国产血液净化产品临床应用评价研究
【分类号】：R541.62;R692.5

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