CRRT联合新活素治疗脓毒血症合并心力衰竭疗效及对血清和心功能相关指标的影响  

Efficacy of CRRT combined with lyophilized recombinant human brain natriuretic peptide on sepsis with heart failure and its effects on serum PCT,IL-6,C-RP and cardiac function indexes

作　　者：吴佳妮[1] 成群 高光霞 付欢 靳琳[1] WU Jiani;CHENG Qun;GAO Guangxia;FU Huan;JIN Lin(Department of Critical Care Medicine,The Sixth People’s Hospital of Chengdu,Chengdu 610051,China)

机构地区：[1]成都市第六人民医院重症医学科,四川成都610051

出　　处：《西部医学》2021年第10期1526-1530,1535,共6页Medical Journal of West China

基　　金：四川省科技计划项目(2019YJ0659)。

摘　　要：目的探讨连续性肾脏替代治疗(CRRT)联合新活素(冻干重组人脑利钠肽)对脓毒血症合并心力衰竭患者的治疗效果及对血清和心功能相关指标的影响。方法选取2019年1月~2020年12月我院重症监护室(ICU)收治的104例脓毒血症合并心力衰竭患者为研究对象。采用随机数字表法分为观察组和对照组,每组各52例。对照组采用新活素及常规药物辅助治疗,观察组在对照组的基础上采用CRRT联合治疗。比较两组治疗前及治疗7 d后血清炎症因子[降钙素原(PCT)、白细胞介素6(IL-6)、C-反应蛋白(C-RP)]水平、心功能指标[左心室射血分数(LVEF)、二尖瓣舒张早期充盈峰速度E峰和舒张晚期充盈峰速度A峰比值(E/A)、B型尿钠肽(BNP)、氨基末端B型尿钠肽前体(NT-proBNP)]变化、血流动力学指标[心率(HR)、平均动脉压(MAP)、心输出量(CO)]及血流变学指标(全血高切粘度、血浆粘度及血红细胞比容)变化;比较两组入组(入ICU的24 h内)时的急性生理和慢性健康状况评价系统(APACHE)Ⅱ评分及预期死亡率,并记录两组入组28 d内的实际死亡率。结果治疗7 d后,两组血清PCT、IL-6、C-RP、BNP及NT-proBNP含量较治疗前均明显降低,且观察组均显著低于对照组(P<0.05);治疗7 d后,两组心脏LVEF和E/A指数较治疗前均明显升高,而观察组与对照组无显著差异(P>0.05);两组CO指数于治疗7 d后明显高于同组治疗前,且观察组显著高于对照组(P<0.05),而两组HR、MAP指数于治疗前后均显著改善,但观察组与对照组间无显著差异(P>0.05);治疗7 d后,两组全血高切粘度、红细胞比容较治疗前均明显降低,且观察组均显著低于对照组(P<0.05),两组血浆粘度均显著低于治疗前(P<0.05),但两组间比较无明显差异(P>0.05);两组入组时APACHEⅡ评分及预期死亡率无明显差异(P>0.05);而观察组入组28 d内的实际死亡率显著低于对照组(P<0.05)。结论连续性肾脏替代治疗联合新活Objective To analyze the therapeutic efficacy of continuous renal replacement therapy(CRRT)combined with Xinhuosu(lyophilized recombinant human brain natriuretic peptide)on patients with sepsis complicated with heart failure and its effects on serum and cardiac function-related indexes.Methods A total of 104 patients with sepsis complicated with heart failure who were treated in intensive care unit(ICU)of our hospital from January 2019 to December 2020 were selected as the research subjects,and they were divided into experimental group and control group according to the random number table method,with 52 cases in each group.Control group was treated with lyophilized recombinant human brain natriuretic peptide and conventional drug adjuvant therapy,and experimental group was combined with CRRT on the basis of control group.The levels of serum inflammatory factors(procalcitonin(PCT),interleukin 6(IL-6),C-reactive protein(C-RP))and cardiac function indexes(left ventricular ejection fraction(LVEF),ratio of peak E velocity of early mitral valve diastole and peak A velocity of late diastole(E/A),B-type natriuretic peptide(BNP),N-terminal pro-brain natriuretic peptide(NT-proBNP))were compared between the two groups before treatment and after 7d of treatment.The hemodynamic indexes(heart rate(HR),mean arterial pressure(MAP),cardiac output(CO))and hemorheology indexes(whole blood high-shear viscosity,plasma viscosity,hematocrit)were compared between the two groups before treatment and after 7d of treatment.Acute Physiological and Chronic Health Evaluation(APACHE)II score and expected mortality rate were compared between the two groups at the time of admission(within 24h of entering the ICU),and the actual mortality rate within 28d of admission was recorded in the two groups.Results After 7d of treatment,the levels of serum PCT,IL-6,C-RP,BNP and NT-proBNP in the two groups were significantly decreased compared with those before treatment,and the levels in experimental group were significantly lower than those in control gr

关 键 词：脓毒血症 心力衰竭 连续性肾脏替代治疗 新活素 血清炎症因子 心功能 

分 类 号：R631[医药卫生—外科学] R541.6[医药卫生—临床医学]