连续性肾脏替代治疗对1型心肾综合征的临床作用研究

发布时间：2018-04-06 02:39

本文选题：型心肾综合征　切入点：连续性肾脏替代治疗　出处：《中国实用内科杂志》2016年07期

【摘要】：目的探讨连续性肾脏替代治疗(CRRT)在1型心肾综合征(CRS)患者中的治疗作用。方法回顾性分析了2011年10月到2015年10月中山大学附属第一医院心脏重症监护室因急性失代偿心力衰竭入院,后出现急性肾损害和(或)利尿剂抵抗,进行CRRT治疗的成人患者的资料。研究主要终点为住院期间的病死率,并进一步评估住院期间患者死亡的独立危险因素。结果 1型CRS患者行CRRT治疗的院内病死率为48%(12/25),出院患者需要规律透析的比例为45%(6/13)。CRRT治疗48 h后较治疗前心率(次/min)显著下降(87±15对100±17,P0.001),NT-pro BNP(ng/L)也显著下降[26990(8710~50106)对34968(13914~55822),P=0.002];1型CRS患者进行CRRT治疗的住院期间死亡的独立危险因素为左室舒张末内径LVED(OR 1.282,95%CI 1.049~1.568,P=0.015)和CRRT治疗次数(OR 1.180,95%CI 1.011~1.377,P=0.036)。结论 1型CRS患者行CRRT治疗48 h后部分实验室和临床指标较治疗前好转,但患者住院期间仍然有着很高的病死率,尤其是那些CRRT治疗次数较多和LVED值较高的患者。因而CRRT对于1型CRS患者预后的改善仍不明确。
[Abstract]:Objective to investigate the effect of continuous renal replacement therapy (CRRT) in patients with type 1 cardiorenal syndrome (CRS).Methods from October 2011 to October 2015, the cardiac intensive care unit of the first affiliated Hospital of Sun Yat-sen University was hospitalized with acute decompensated heart failure and developed acute renal damage and / or diuretic resistance.Data of adult patients treated with CRRT.The primary end point of the study was hospitalization mortality and further assessment of independent risk factors for death during hospitalization.The independent risk factors for death during hospitalization after CRRT treatment were left ventricular end-diastolic diameter (LVED(OR 1.282) and CRRT treatment frequency (OR 1.180) and left ventricular end-diastolic diameter (LVED(OR 1.282) and CRRT treatment frequency (OR 1.180).Conclusion some laboratory and clinical indexes of patients with type 1 CRS treated with CRRT for 48 hours were better than those before treatment, but there was still a high fatality rate during hospitalization, especially in those patients with higher LVED value and more times of CRRT treatment.Therefore, the prognosis of type 1 CRS patients with CRRT is still unclear.
【作者单位】：中山大学附属第一医院心血管内科;深圳市孙逸仙心血管医院心内科;
【分类号】：R692;R541

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