连续性血液净化救治危重心肾综合征对患者预后的影响  

Continuous blood purification remedy contributes to prognosis of CRS patients

作　　者：贾凤玉[1] 孟建中[1] 荣鹏[1] 王素霞[1] 景颖[1] 葛彦明[1] 岳冀[1] 

机构地区：[1]济南军区总医院血液净化科,250031

出　　处：《中华临床医师杂志（电子版）》2011年第15期4390-4393,共4页Chinese Journal of Clinicians(Electronic Edition)

基　　金：全军"十一五"重点计划项目:体外血液净化疗法救治"生物活性化合物伤害综合征"的研究(CJN08L033)

摘　　要：目的探讨连续性血液净化(CBP)对危重心肾综合征(CRS)患者预后的影响。方法选取2007年5月至2010年10月救治的27例慢性心力衰竭(CHF)并发急性肾损伤(AKI)患者。采用无创血液动力仪动态观察CBP治疗24h、48h、72h、96h、120h的心输出量(CO)、外周血管阻力(SVR)、胸腔液体水平(TFC)、中心静脉压(CVP)、尿量及急性生理和慢性健康评估(APACHEⅡ)评分值的变化;同步观察血肌酐(Scr)、半胱氨酸蛋白酶抑制剂C(CysC)、高敏C反应蛋白(hs-CRP)、血钠(Na+)等水平的动态变化;观察患者28d的病死率。结果 CBP治疗24h,水、电解质紊乱、酸中毒得以矫治,Scr和CysC浓度明显降低,患者CO提高,SVR、TFC和CVP水平降低。CBP治疗72h,hs-CRP水平和APACHEⅡ评分值与治疗前相比均明显降低(均P<0.01)。24例患者经CBP治疗72～120h脱离少尿期,并恢复对利尿剂的敏感性,28d病死率为11.12%。结论 CBP能改善心肌功能,缩短少尿期,降低病死率,改善CRS的预后。Objective To approach continuous blood purification(CBP) remedy contributes to prognosis of patients with cardiorenal syndrome(CRS).Methods 27 patients with chronic heart failure(CHF) complicating acute kidney injury(AKI) were selected from May 2007 to October 2010.Cardiac output(CO),systemic vascular resistance(SVR),thoracic fluid capacity(TFC),central venous pressure(CVP) were observed separately at 24 h,48 h,72 h,96 h,120 h after CBP treatment by non-invasive hemodynamics monitoring system.Urinary volume and acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score were observed synchronously.Dynamic state change of serum creatinine(Scr),cysteine proteinase inhibitors C(CysC),high sensitive C-reactive protein(hs-CRP),serum sodium level(Na+) were observed at the same time.Record their fatality rate at the 28 d.Results After 24 h CBP treatment,fluid and electrolyte imbalance,acidosis were treated well,concentration of Scr and CysC decreased obviously,level of CO got improved,while SVR,TFC and CVP got decreased.hs-CRP level and APACHE II score were significantly decreased after 72 h CBP treatment(both P<0.01).After 72-120 h CBP treatment,24 patients break away from the oliguria stage and their sensibility to diuretics got recuperated,fatality rate in the 28 d was 11.12%.Conclusions CBP treatment could improve myocardial function,shorten oliguria stage,decrease fatality rate and improve the prognosis of CRS patients.

关 键 词：肾透析 心力衰竭 肾损伤 

分 类 号：R541.61[医药卫生—心血管疾病] R692[医药卫生—内科学]