床旁血滤联合BiPAP无创机械通气治疗难治性终末期心衰效果观察  

Clinical effect of continuous renal replacement therapy(CRRT) combined with Bi PAP noninvasive ventilation in the treatment of refractory end-stage heart failure

作　　者：王霞[1] 陈晋波[1] 梁小华[1] 

机构地区：[1]石家庄市第二医院心内科三病区,河北石家庄050051

出　　处：《海南医学》2015年第2期169-171,共3页Hainan Medical Journal

基　　金：河北省重点科研计划项目(编号:ZD20140272)

摘　　要：目的探讨床旁血液滤过(CRRT)联合Bi PAP无创机械通气治疗顽固性心力衰竭的临床治疗效果。方法根据治疗方法不同将我院300例顽固性心力衰竭患者分为两组,均给予标准药物治疗,对照组143例加用Bi PAP无创机械通气治疗、研究组157例应用连续性CRRT联合Bi PAP无创机械通气治疗,观察治疗前后两组患者的生命体征、NT-pro-BNP、左室射血分数、血肌酐、动脉氧分压等指标的变化和治疗效果。结果对照组治疗前后NT-pro-BNP值分别为(1 996±63.7)pg/ml和(875±29.4)pg/ml,研究组分别为(2 096±62.8)pg/ml、(565±30.0)pg/ml;两组患者治疗后NT-pro-BNP值均明显降低,与治疗前比较差异均有统计学意义(P<0.01),研究组疗效更佳;对照组治疗前后血氧分压分别为(69.96±6.37)mm Hg和(87.5±2.94)mm Hg,研究组分别为(68.86±6.28)mm Hg和(92.5±3.00)mm Hg;两组患者治疗后血氧分压值均明显升高,与治疗前比较差异均有统计学意义(P<0.01);研究组患者治疗后血氧分压值明显低于对照组,且两组间比较差异有统计学意义(P<0.01);对照组治疗前后肌酐值分别为(199.6±63.7)μmol/L和(87.5±2.94)μmol/L,研究组分别为(198.6±62.8)μmol/L和(76.5±3.00)μmol/L,两组患者治疗后血肌酐值均明显降低,与治疗前比较差异均有统计学意义(P<0.01);研究组患者治疗后血肌酐值明显低于对照组,且两组间比较差异有统计学意义(P<0.05);研究组患者治疗后胸片渗出水肿改变及心脏彩超改变有效率为84.7%,对照组为71.3%,两组间比较差异有统计学意义(P<0.05);研究组患者治疗后呼吸困难症状及心功能分级及活动能力有效率为82.8%,对照组为69.9%,两组间比较差异有统计学意义(P<0.05);研究组患者生存率为86.0%,对照组为76.9%,两组患者生存率比较差异有统计学意义(P<0.05)。结论床旁血液滤过联合Bi PAP无创机械通气治疗能有效缓解顽固性心力衰竭的临床症状,改善心功能,提高了抢救Objective To explore the clinical effect of continuous renal replacement therapy（CRRT） combined with Bi PAP noninvasive ventilation on refractory end-stage heart failure.Methods Three hundred patients cases with refractory end-stage heart failure were divided into two groups according to different treatment in our hospital.All of them were given standard drug.In control group,143 patients were given Bi PAP,while in research group,157 patients were given CRRT combined with Bi PAP.The vital signs,NT-pro-BNP,LVEF,CRE,Pa O2 and effect were observed and compared before and after treatment in the two groups.Results Compared to before treatment,the values of NT-pro-BNP after treatment significantly decreased in both control group and research group [（1 996±63.7） pg/ml vs（875±29.4） pg/ml,（2 096±62.8） pg/ml vs（565±30.0） pg/ml,respectively,P〈0.01].The effect was better in research group.After treatment,the Pa O2 in both groups were statistically significantlyincreased than those before treatment[（87.5 ± 2.94） mm Hg vs（69.96 ± 6.37） mm Hg,（92.5 ± 3.00） mm Hg vs（68.86 ± 6.28） mm Hg,respectively,P〈0.01].After treatment,the CRE in both groups were statistically significantly decreased than those before treatment[（199.6 ± 63.7） μmol/L vs（87.5 ± 2.94） μmol/L,（198.6 ± 62.8） μmol/L vs（76.5 ± 3.00） μmol/L,respectively,P〈0.01）.There was a statistically significant difference between the two groups（P〈0.05）.The effective rate of the change on dropsy and exudation on rabat and heart doppler ultrasound,the effective rate on the dyspnea,heart function classification and mobility and the survival rate in the research group were statistically significantly higher than those in the control group（84.7% vs 71.3%,82.8% vs 69.9%,86.0% vs 76.9%,respectively,P〈0.05）.Conclusion CRRT combined with BiPAP noninvasive ventilation could effectively relieve the clinical symptoms,improve the heart function,increase the rate of escue success,which is a positive,safety

关 键 词：床旁血液滤过 双水平气道正压通气 难治性终末期心衰 NT-PRO-BNP 心功能 血肌酐 动脉氧分压 

分 类 号：R541.6[医药卫生—心血管疾病]