监测交感神经系统活性预测急性心力衰竭患者急性肾损伤及预后的前瞻性队列研究  

Prospective cohort study on the prediction of AKI and its prognosis in AHF patients by monitoring sympathetic nervous system activities

作　　者：叶志辉[1] 孙大勇[1] 骆军武 钟和宇 

机构地区：[1]深圳市龙岗中心医院,广东深圳518116

出　　处：《中国医药科学》2016年第11期17-20,共4页China Medicine And Pharmacy

基　　金：广东省深圳市龙岗区科技计划项目(201406063001024)

摘　　要：目的采用前瞻性队列研究的方法探究交感神经系统活性监测在急性心力衰竭（AHF）患者是否发生急性肾损伤（AKI）的预测及预后价值。方法将2014年1月-2016年1月期间在我院接受治疗的AHF患者68例作为研究对象,对其进行前瞻性队列研究。比较发生AKI和未发生AKI的AHF患者的交感神经系统活性指标（心率、血浆去甲肾上腺素水平和心率变异性分析）。结果随访12个月后,68例AHF患者中发生32例AKI,AKI发生率为47.06%（32/68）,AKI患者在年龄,心脏瓣膜病病史、缺血性心脏病病史、高血压病史,心率、血浆去甲肾上腺素水平以及心率变异性分析等方面与非AKI患者差异显著（P〈0.05）。经过药物治疗与连续性肾脏替代治疗,32例AHF合并AKI患者中有23例发生好转,9例经治疗无效或病情加重。AHF合并AKI患者中的好转患者在心率、血浆去假装肾上腺素水平、平均R-R间期等三项交感神经系统活性指标与无效患者差异有统计学意义（P〈0.05）。结论交感神经系统活性对于预测AHF患者AKI及预后具有较高的临床价值,可作为临床常规监测项目。Objective To explore the predictive and prognostic value of sympathetic nervous system activity monitoring on acute kidney injury（AKI） in acute heart failure（AHF） patients by prospective cohort study method. Methods 68 AHF patients who were in our hospital from January 2014 to January 2016 were selected, their clinical data were analyzed by prospective cohort study method. The sympathetic nervous system activity indexes（heart rate, plasma norepinephrine level, and heart rate variability） of AHF patients with AKI and without AKI were compared. Results After a 12-month follow-up, among the 68 AHF patients, there were 32 cases suffered AKI, the incidence of AKI was 47.06%（32/68）, the differences of ages, heart valve disease histories, hypertension histories, heart rates, plasma norepinephrine levels, and heart rate variability between AKI patients and non-AKI patients were statistically significant（P〈0.05）. After drug therapy and continuous renal replacement therapy, among the 32 AHF and AKI patients, there were 23 cases turned better, 9 cases got no improvement or even worse. The differences of three sympathetic nervous system activity indexes— heart rates, plasma norepinephrine levels, and even R-R intervals—between improved cases and invalid cases among the AHF and AKI patients were statistically significant（P〈0.05）. Conclusion The sympathetic nervous system activity is clinical valuable for the predicting and prognosis of AKI in AHF patients, which can be used as a routine monitoring item.

关 键 词：急性心力衰竭 急性肾损伤 交感神经系统活性 前瞻性队列研究 

分 类 号：R541[医药卫生—心血管疾病]