连续性血液净化治疗重度心力衰竭合并肾衰竭的临床观察  

Continuous blood purification for patients with severe heart failure and renal failure

作　　者：张志刚 李晓翔 

机构地区：[1]宁波市北仑区人民医院急诊内科,浙江省宁波315800

出　　处：《中国基层医药》2016年第22期3481-3484,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的：探讨连续性血液净化治疗重度心力衰竭合并肾衰竭患者的临床效果。方法回顾性分析38例采用连续性血液净化治疗的重度心力衰竭合并肾衰竭患者的临床资料，比较患者在连续性血液净化治疗前后呼吸、心率、平均血压、APACHE Ⅱ评分、Boston 评分、血生化、血气分析及心功能变化情况。结果治疗后72 h 患者的呼吸[（19．24±2．88）次／min]、心率[（88．57±15．68）次／min]、APACHE Ⅱ评分[（14．28±3．26）分]及 Boston 评分[（6．27±1．25）分]等指标均较治疗前明显下降（[（35．68±5．97）次／min]、[（131．24±24．26）次／min]、[（26．34±5．96）分]、[（17．88±2．87）分]），且差异均有统计学意义（t ＝3．13、3．45、2．12、4．11、3．67、5．68、3．44、6．09，均 P ＜0．05）。38例重度心力衰竭合并肾衰竭患者经连续性血液净化治疗后，显效16例，有效12例，无效10例，总有效率达73．68％。患者在经过连续性血液净化治疗后，其 SCr[（168．15±31．16）μmol／L]、BUN [（13．13±3．44）mmol／L]均较治疗前明显下降，而 pH[（7．41±0．13）]、HCO3[（25．57±5．11）mmol／L]、PaO2[（88．26±7．72）mmHg]、SaO2[（96．43±3．14）％]等血生化和血气指标则明显升高，且差异均有统计学意义（t ＝4．55、3．21、2．11、3．45、6．73、4．21，均 P ＜0．05）。经超声心动图检查后，发现患者治疗后的心搏量（SV）[（59．31±6．58）mL／次]、心排血量（CO）[（4．57±0．62）L／min]及左室射血分数（LVEF）[（68．12±4．88）％]等心功能指标均较治疗前明显升高，且差异均有统计学意义（t ＝4．33、5．12、3．67，均 P ＜0．05）。结论连续性血液净化可以有效保持患者的血流动力学稳定，可以安全有效地治疗重度心力衰竭合并肾衰竭。Objective To investigate the clinical effect of continuous blood purification therapy in patients with severe heart failure and renal failure.Methods The clinical data of 38 patients with severe heart failure and renal failure treated by continuous blood purification were analyzed retrospectively.Heart rate,mean blood pressure, APACHE II score,Boston score,blood biochemistry,blood gas analysis and cardiac function changes were compared before and after the treatment of continuous blood purification.Results After treatment 12h and 72h,patients breath-ing[（19.24 ±2.88）times/min],heart rate[（88.57 ±15.68）times/min],APACHE Ⅱ [（14.28 ±3.26）points] and the score of Boston[（6.27 ±1.25 ）points]were significantly decreased compared with those before treatment [（35.68 ±5.97）time /min,（131.24 ±24.26）time /min,（26.34 ±5.96）points,（17.88 ±2.87）points],and the differences were statistically significant （t =3.13 3.45,2.12,4.11,3.67,5.68,3.44,609,all P 〈0.05）.38 cases of severe heart failure with renal failure after continuous blood purification treatment,markedly effective in 16 cases, effective in 12 cases,ineffective in 10 cases,the total effective rate was 73.68%.Patients after continuous blood purification treatment,the SCr[（168.15 ±31.16）μmol/L],BUN [（13.13 ±3.44）mmol/L]were significantly decreased.pH[（7.41 ±0.13）],HCO3 [（25.57 ±5.11）mmol/L],PaO2 [（88.26 ±7.72）mmHg],SaO2 [（96.43 ± 3.14）%]and blood biochemistry and blood gas index decreased markedly,and the differences were statistically significant （t =4.55,3.21,2.11,3.45,673,4.21,all P 〈0.05）.After the examination of echocardiography,stroke volume （SV）[（59.31 ±6.58）mL],cardiac output （CO）[（4.57 ±0.62）L/min]and left ventricular ejection fraction （LVEF）[（68.12 ±4.88）%]increased significantly compared with before treatment,and the differences were statistically significant （t =4.33,5.12,367,all P 〈0.05）.Conclusion Continuous blood purification could＆amp;nbs

关 键 词：血液滤过 心力衰竭 充血性 肾功能衰竭 

分 类 号：R541.6[医药卫生—心血管疾病] R692.5[医药卫生—内科学]