连续性血液净化治疗心功能不全合并急性肾损伤时效性研究  

Timing of continuous blood purification in patients with acute renal injury and heart failure

作　　者：李旭 于亚楠[2] 李秀姿 孟思妤[2] 杜玉颖 常莉[2] 姚天明 LI Xu;YU Ya-nan;LI Xiu-zi;MENG Si-yu;DU Yu-ying;CHANG Li;YAO Tian-ming(Department of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]北部战区总医院先心内科,辽宁沈阳110016 [2]沈阳药科大学生命科学与生物制药学院,辽宁沈阳110000 [3]锦州医科大学研究生院,辽宁锦州121000 [4]北部战区总医院医务部,辽宁沈阳110016

出　　处：《创伤与急危重病医学》2018年第6期386-388,共3页Trauma and Critical Care Medicine

基　　金：辽宁省自然科学基金(201602800);中国博士后科学基金(2016M603067);全军医学科技拔尖人才项目(16QNP064)

摘　　要：目的探讨连续性血液净化(CBP)治疗心功能不全合并急性肾损伤的最佳时机。方法选取自2013年1月至2017年1月就诊于北部战区总医院并接受CBP治疗的77例心功能不全合并急性肾损伤患者为研究对象。按照入院到启动CBP治疗的时间将患者分为早期组(n=45)和晚期组(n=32),再依据RIFLE分期诊断标准将两组组内再分为R组和I+F组,比较CBP治疗后各组的在院病死率、出院28 d病死率及出院后6个月病死率。结果早期组患者在院病死率、出院28 d病死率以及出院6个月病死率均明显低于晚期组,组间比较,差异有统计学意义(P <0. 05)。早期组中,R组患者在院病死率、出院6个月病死率均低于I+F组,差异均有统计学意义(P <0. 05);晚期组中,R组与I+F组患者在院病死率、出院28 d病死率及出院后6个月病死率比较,差异均无统计学意义(P> 0. 05)。结论入院24 h内启动CBP可降低心功能不全合并急性肾损伤患者的病死率,RIFLE分期为R期的患者可获得更好的疗效。Objective To investigate the timing of continuous blood purification（CBP）in patients with acute renal injury and heart failure.Methods A retrospective study was performed on 77 cases of patients with cardiac insufficiency combined acute kidney injury who were admitted and treated with CBP from January 2013 to January 2017.According to the length of time from hospital admission to initiation of CBP treatment,patients were divided into the early stage group（ n =45）and the advanced stage group（ n =32）.According to the diagnostic criteria of RIFLE staging,the two groups were divided into the R group and I＋F group.The hospital fatality rate,the hospital mortality of each group after CBP treatment,the hospital mortality of 28 days after discharge and the hospital mortality of 6 months after discharge were compared.Results In-hospital mortality rate,28-day mortality rate and half-year mortality rate in the early group were lower than those in the advanced group,and the difference was statistically significant（ P 〈0.05）.In the early group,in-hospital mortality rate and half-year mortality rate in R group were lower than those in the I＋F group,and the difference was statistically significant（ P 〈0.05）.In the advanced group,there was no statistically significant difference in in-hospital mortality,28-day mortality and half-year mortality rate between R group and I＋F group（ P 〉0.05）.Conclusion For patients with cardiac insufficiency and acute kidney injury,starting CBP within 24 hours after admission can reduce mortality rate.

关 键 词：心功能不全 急性肾损伤 连续性血液净化 连续性肾替代治疗 

分 类 号：R541.6[医药卫生—心血管疾病]