无创机械通气联合CRRT治疗CKD急性加重合并AHF患者的疗效分析  

Efficacy analysis of non-invasive mechanical ventilation combined with CRRT in patients with acute exacerbation of chronic kidney disease complicated with acute heart failure

作　　者：尹成伟[1] 张涛[1] YIN Chengwei;ZHANG Tao(Department of Emergency,Shuguang Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200021,China)

机构地区：[1]上海中医药大学附属曙光医院急诊科,上海200021

出　　处：《检验医学与临床》2022年第21期2903-2906,共4页Laboratory Medicine and Clinic

基　　金：上海市卫生健康委员会科研课题(SHSLCZDZK04402)。

摘　　要：目的比较无创机械通气联合连续性肾脏替代治疗(CRRT)对慢性肾脏病(CKD)急性加重合并急性心力衰竭(AHF)患者心肾功能及预后的影响。方法收集2020年1月至2021年12月该院综合重症监护室(ICU)收治的CKD急性加重合并AHF患者62例作为研究对象。研究对象按照随机数字表法分为CRRT组(n=31)、联合组(n=31),在两组都予以CRRT治疗的基础上,联合组予以联合无创机械通气。比较两组治疗前后血气指标、心肾功能指标变化及预后。结果与治疗前比较,治疗后24 h联合组各血气指标(动脉血二氧化碳分压、动脉血氧分压、血氧饱和度)显著改善(P<0.05),且联合组治疗后24、48 h各血气指标均显著优于CRRT组(P<0.05)。治疗后24 h,两组尿素氮、血肌酐、B型钠尿肽(BNP)、肌钙蛋白I(cTnI)水平均显著改善(P<0.05),联合组BNP、cTnI水平明显低于CRRT组(P<0.05),治疗后48 h联合组各心肾功能指标均明显低于CRRT组(P<0.05)。与CRRT组比较,联合组ICU住院时间明显缩短,气管插管率明显下降(P<0.05)。结论无创机械通气联合CRRT是治疗CKD急性加重合并AHF患者的一种安全有效的方法,有利于快速改善氧合和心肾功能指标,改善患者预后。Objective To discuss the effects of non-invasive mechanical ventilation combined with continuous renal replacement therapy(CRRT)on cardio-renal function and prognosis in patients with acute exacerbation of chronic kidney disease(CKD)complicated with acute heart failure(AHF).Methods A total of 62 patients with acute exacerbation of CKD complicated with AHF admitted to the comprehensive ICU of our hospital from January 2020 to December 2021 were collected as the research objects.According to the random number table method,the research objects were divided into CRRT group(n=31)and combined group(n=31).On the basis of CRRT treatment in both groups,the combined group was also given non-invasive mechanical ventilation.The changes of blood gas indexes,cardiac and renal function indexes and prognosis of the two groups were compared before and after treatment.Results Compared with before treatment,the blood gas indexes of PaCO_(2),PaO_(2) and SpO_(2) in the combination group at 24 h after treatment were significantly improved(P<0.05),and the blood gas indexes at 24 h and 48 h after treatment in combined group were significantly better than those in the CRRT group(P<0.05).The levels of BUN,Scr,BNP,and cTnI at 24 h after treatment in both groups were significantly improved(P<0.05),the levels of BNP and cTnI in the combined group were significantly lower than those in the CRRT group(P<0.05),and all indexes of cardiac and renal function in the combined group were significantly lower than those in the CRRT group at 48 h after treatment(P<0.05).Compared with CRRT group,the ICU hospitalization time and intubation rate of combined group were significantly shortened(P<0.05).Conclusion CRRT combined with non-invasive mechanical ventilation is a safe and effective method for the treatment of patients with acute exacerbation of CKD complicated with AHF,which is beneficial to rapidly improve oxygenation and cardio-renal function indexes,and improve the prognosis.

关 键 词：无创机械通气 连续性肾脏替代治疗 慢性肾脏病急性加重 急性心力衰竭 

分 类 号：R459.9[医药卫生—治疗学]