连续血液滤过对预防老年急性心肌梗死患者冠脉介入术后心功能不全的效果  

Effect of continuous hemofiltration on prevention of cardiac insufficiency after coronary intervention in elderly patients with acute myocardial infarction

作　　者：刘胜子 罗敏虹 孙凌 梁建文 LIU Sheng-zi;LUO Min-hong;SUN Ling;LIANG Jian-wen(Chest Pain Center, the Eighth Affiliated Hospital (Shenzhen Futian), Sun Yat - sen University, Shenzhen 518003 , Guangdong, China)

机构地区：[1]中山大学附属第八医院(深圳福田)胸痛中心

出　　处：《广东医学》2019年第15期2154-2157,共4页Guangdong Medical Journal

基　　金：广东省科技计划项目(编号:2017A020215130);深圳市福田区卫生公益性科研项目(编号:FTWS2017007)

摘　　要：目的探讨老年心肌梗死患者急诊冠脉介入术后预防性连续静脉-静脉血液滤过(CVVHF)能否减少心功能不全和造影剂肾病的发生、发展。方法入组胸痛中心疑诊或确诊急性心肌梗死且既往无肾病史并行急诊介入治疗的老年患者(≥65岁)60例,按年龄匹配分为对照组(n=28)和CVVHF组(n=32)。CVVHF组在术后即刻给予床旁血液透析6~8 h,对照组术后给予等渗盐水1 mL/(kg·min)静脉泵入维持12 h。检测冠脉造影前和造影后第2、3天及1周的血浆N端前体脑利钠肽(NTpro-BNP)、血肌酐、血尿素氮、肾小球滤过率及心脏超声。结果术后第2天两组的NTpro-BNP、肾小球滤过率(eGFR)差异无统计学意义(P>0.05),术后第3天、1周CVVHF组的NTpro-BNP、血肌酐下降幅度较对照组明显(P<0.01);两组术后1周eGFR较术后第2天改善(P<0.05),而左室舒张末直径(P=0.065)及左室射血分数(P=0.12)差异无统计学意义;对照组有4例(14.3%)发生造影剂肾病,其中2例(7.1%)进展至慢性肾脏病(CKD)Ⅲ期需肾内科治疗,1例(7.1%)发生急性左心衰竭需CVVHF治疗,CVVHF组无一例发生造影剂肾病及急性左心衰竭,两组比较差异有统计学意义(P<0.01)。结论老年急性心肌梗死患者急诊冠脉介入治疗术后予CVVHF治疗可预防心功能不全的发生,CVVHF和常规水化均可预防造影剂肾病的发生,CVVHF较常规水化能更好地预防术后急性期CIN。Objective To explore whether preventive continuous veno-venous hemofiltration(CVVHF) could reduce the occurrence of cardiac insufficiency and contrast-induced nephropathy in elderly patients with myocardial infarction after emergency coronary intervention. Methods Sixty elderly patients(>65 years old) with suspected or confirmed acute myocardial infarction, with no history of nephropathy were enrolled in this study. They were divided into routine treatment group(28 cases) and CVVHF group(32 cases) according to their age. CVVHF group was given bedside hemodialysis for 6-8 hours immediately after operation, while the control group was given isotonic saline 1 mL/kg/min for 12 hours after operation. The plasma pro-BNP, serum creatinine, blood urea nitrogen, glomerular filtration rate and cardiac ultrasound were measured before, 2-3 day after and 1 week after coronary angiography. Results There was no significant difference at baseline between the two groups. On the 2 nd day after operation, there was no significant difference in NTpro-BNP or eGFR between the two groups(P>0.05). On the 3 rd day and the first week after operation, NTpro-BNP and serum creatinine in CVVHF group were significantly reduced compared with the control group(P<0.01). eGFR in the 1 st week after operation was significantly improved compared with the 2 nd day after operation(P<0.05), while left ventricular end-diastolic diameter or left ventricular ejection fraction showed no significant difference between the two groups(LVIDd P=0.065, EF P=0.12). Contrast-enhanced nephropathy was developed in 4 cases(14.3%) in the control group, among whom 2 cases developed to Stage III of chronic kidney disease(CKD)(7.1%) required nephrological treatment, and 1 case with acute left heart failure(7.1%), required CVVHF treatment, None of the CVVHF group had contrast-induced nephropathy or acute left heart failure(P<0.01). Conclusion CVVHF can prevent the occurrence of cardiac insufficiency in elderly patients with acute myocardial infarction after emergency coro

关 键 词：血液滤过透析 急性心肌梗死 心功能不全 

分 类 号：R459.5[医药卫生—治疗学] R542.22[医药卫生—临床医学]