4种血液净化方式治疗老年Ⅰ型心肾综合征的疗效评估  

Evaluation of Therapeutic Effects of Four Blood Purification Methods on Cardiorenal Syndrome Type 1 in Elderly People

作　　者：生杰[1] 王媛[1] 刘春艳[1] 王莺燕[2] 

机构地区：[1]大连医科大学附属第二医院肾内科,辽宁省大连市116023 [2]大连医科大学临床技能教研室

出　　处：《中国全科医学》2015年第22期2671-2675,共5页Chinese General Practice

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

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(P>0.05)。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(P<0.05);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(P<0.05)。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(P>0.05)。而治疗后4组患者LDV、CO、LVEF、CVP比较,差异均有统计学意义(P<0.05);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(P<0.05)。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(P<0.05);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(P<0.05)。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。Objective To investigate the therapeutic effects of four blood purification methods on cardiorenal syndrome （CRS） type 1 in elderly people. Methods We enrolled 198 elderly patients with CRS type 1 who were admitted into the Cardiology Department and Nephrology Department in the Second Affiliated Hospital of Dalian Medical University from February 2011 to August 2014. According to blood purification method, the subjects were divided into four groups： UF group （n = 41 ）, SCUF group （ n = 44 ）, IHD group （ n = 52 ） and CVVH group （ n = 61 ） . Physicochemical indexes were examined before treatment and 24 hours after the first treatment, and the improvement of cardiorenal function was examined one week after treatment. Results Before treatment , the four groups were not significantly different （P〉0.05）inUrea, SCr, K, Na, BNP, Tn - I level and MAP. After treatment, the four groups were significantly different （P 〈 0.05） in the levels of Urea, SCr, K, Na, BNP and Tn-I and MAP; SCUF group, IHD group and CVVH group were significantly different （P 〈0. 05） from UF group in the levels of Urea, SCr, K, Na, BNP and Tn - I and MAP; IHD group was significantly different （P 〈 0. 05 ） from SCUF group in the levels of serum K and BNP; CVVH group was significantly different （P 〈 0. 05） from SCUF group in the levels of serum Urea, SCr, K, BNP and Tn - I ; CVVH group was significantly different （P 〈 0.05） from IHD group in the levels of Urea, SCr, BNP and Tn - I. Before treatment, the four groups were not significantly different （ P 〉 0.05 ） in LDV, CO, LVEF and CVP. After treatment, the four groups were significantly different （P 〈 0.05 ） in LDV, CO, LVEF and CVP; SCUF group and IHD group were significantly different （P 〈 0.05 ） from UF group in LDV, CO, LVEF and CVP; CVVH group was significantly different （P 〈 0. 05） from UF group, SCUF group and IHD group in LDV, CO, LVEF and CVP. The four groups were significantly different （P 〈 0. 05） in the i

关 键 词：老年人 心肾综合征 血液滤过 治疗结果 

分 类 号：R541.82[医药卫生—心血管疾病]