重组人脑利钠肽结合床旁血液净化对慢性心力衰竭伴急性肾损伤患者血流动力学和心、肾功能的影响  

Effects of recombinant human brain natriuretic peptide combined with bedside blood purification on hemodynamics and heart and kidney function in patients with chronic heart failure complicated with acute kidney injury

作　　者：周恒杰[1] 刘思伯[1] 刘国梁[1] Zhou Hengjie;Liu Sibo;Liu Guoliang(The Central Hospital of Dalian,Dalian 116000,China)

机构地区：[1]辽宁省大连市中心医院外科ICU,大连116000

出　　处：《广西医科大学学报》2018年第11期1535-1538,共4页Journal of Guangxi Medical University

摘　　要：目的:探究重组人脑利钠肽(rhBNP)结合床旁血液净化对慢性心力衰竭(CHF)伴急性肾损伤(AKI)患者血流动力学和心、肾功能的影响。方法:选取2016年7月至2017年12月辽宁省大连市中心医院收治的94例CHF伴AKI患者,按随机数字表法分为观察组和对照组,每组47例。观察组患者予以rhBNP+床旁血液净化治疗,对照组患者予以床旁血液净化治疗。比较两组治疗前、后心排出量(CO)、中心静脉压(CVP)、平均肺动脉压(mPAP)、肺动脉楔压(PAWP)、心率(HR)、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、血肌酐(Scr)、尿素氮(BUN)、肾小球滤过率(GFR)及急性生理与慢性健康评分(APACHEⅡ)。结果:治疗48h后,两组CO较治疗前明显升高,CVP、mPAP、PAWP明显降低,且观察组变化更为显著(P<0.05)。治疗7d后,两组HR、LVESD、LVEDD、血清Scr和BUN水平及APACHEⅡ评分均较治疗前明显降低,LVEF和GFR明显升高,且观察组变化更为显著(P<0.05)。结论:rhBNP结合床旁血液净化可有效改善CHF伴AKI患者的心、肾功能,利于稳定血流动力学,改善预后。Objective： To explore the effects of recombinant human brain natriuretic peptide （rhBNP） combined with bedside blood purification on hemodynamics and heart and kidney function in patients with chronic heart failure （CHF） complicated with acute kidney injury （AKI）.Methods： A total of 94 patients with CHF and AKI in our hospital form July 2006 to December 2017 were selected, and randomly divided into an observation group and a control group, with 47 cases in each group. The patients in the control group received bedside blood purification, and those in the observation group received rhBNP combined with bedside blood purification. The cardiac output （CO）, central venous pressure （CVP）, mean pulmonary artery pressure （mPAP）, pulmonary artery wedge pressure （PAWP）, heart rate （HR）, left ventricular end-systolic diameter （LVESD）, left ventricular end-diastolic dimension （LVEDD）, left ventricular ejection fraction （LVEF）, and serum levels of creatinine （Scr）, urea nitrogen （BUN）, glomerular filtration rate （GFR） as well as acute physiology and chronic healthy evaluation （APACHEⅡ） were observed before and after treatment.Results： After 48 h of treatment, the CO was increased, while the CVP, mPAP and PAWP were decreased in both groups （ P 〈0.05）. After 7 days of treatment, the HR, LVESD, LVEDD, and serum levels of Scr and BUN as well as the APACHEⅡscore were decreased, while the LVEF and GFR were increased in both groups （ P 〈0.05）. These changes were more significant in the observation group （ P 〈0.05）.Conclusion： rhBNP combined with bedside blood purification could improve the heart and kidney function and prognosis, and stabilize hemodynamics in patients with CHF and AKI.

关 键 词：RHBNP 床旁血液净化 CHF AKI 血流动力学 

分 类 号：R541.6[医药卫生—心血管疾病]