利尿剂联合RAAS拮抗剂对心肾综合征的治疗作用  

Therapeutic Effect of Diuretics Combined with RAAS Antagonists on Cardiorenal Syndrome

作　　者：罗洋 李力 叶兴文 喻秋平 杨蕙文 LUO Yang;LI Li;YE Xingwen;YU Qiuping;YANG Huiwen(Jiujiang University Affiliated Hospital,Jiujiang 332000,China)

机构地区：[1]九江学院附属医院,江西九江332000

出　　处：《中国医学创新》2023年第19期76-81,共6页Medical Innovation of China

基　　金：江西省卫生计生委科技计划项目(20181654)。

摘　　要：目的:探究利尿剂联合肾素-血管紧张素-醛固酮系统(RAAS)拮抗剂对心肾综合征患者的治疗作用。方法:从2019年1月—2022年12月九江学院附属医院收治的心肾综合征患者中选取120例作为研究对象进行回顾性研究,根据治疗方式分为常规组、联合用药组及血液滤过组,每组40例。常规组给予常规对症治疗,联合用药组给予利尿剂联合RAAS拮抗剂治疗,血液滤过组采用床旁血液滤过治疗,比较三组治疗效果、治疗前后日尿量情况、尿钠情况、呼吸困难等临床指标及心、肾功能指标。结果:治疗前,三组临床指标水平差异无统计学意义(P>0.05);治疗后三组临床指标均有改善,且联合用药组改善更明显,差异均有统计学意义(P<0.05);联合用药组总有效率为92.50%,常规组为62.50%,血液滤过组为85.00%,差异有统计学意义(P<0.05);治疗后,联合用药组和血液滤过组的左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、B型脑钠肽(BNP)水平均明显降低(P<0.05),左心室射血分数(LVEF)水平均较治疗前有所改善(P<0.05),常规组的LVEDD、LVESD水平治疗前后差异均无统计学意义(P>0.05);与常规组相比,联合用药组治疗后LVEF水平显著更高,LVEDD、LVESD、BNP水平均显著更低,差异均有统计学意义(P<0.05)。与血液滤过组相比,联合用药组治疗后LVEF水平显著更高,LVEDD、LVESD水平均显著更低,差异均有统计学意义(P<0.05)。治疗后,三组血肌酐(Scr)、尿素氮(BUN)、血清胱抑素(Cys C)较治疗前均有所下降(P<0.05);与常规组相比,联合用药组治疗后Scr、BUN、Cys C水平均显著更低,差异均有统计学意义(P<0.05)。与血液滤过组相比,联合用药组治疗后Scr、BUN、Cys C水平均显著更低,差异均有统计学意义(P<0.05)。三组住院时间、出院不良事件发生率比较,差异均有统计学意义(P<0.05),联合用药组最优。结论:利尿剂联合RAAS拮抗剂可有效改善心肾综�Objective:To explore the therapeutic effect of diuretics combined with RAAS antagonists on patients with cardiorenal syndrome.Method:From January 2019 to December 2022,120 patients with cardiorenal syndrome in Jiujiang University Affiliated Hospital were selected as the research object for retrospective study,and were divided into routine group,combined medication group and hemofiltration group according to the treatment methods,with 40 cases in each group.The routine group was given routine symptomatic treatment,the combined medication group was given diuretics combined with RAAS antagonist treatment,and the hemofiltration group was given bedside hemofiltration treatment.The therapeutic effect,daily urine volume,urinary sodium,dyspnea and other clinical indicators and cardiac and renal function indexes of the three groups were compared.Result:Before treatment,there were no significant differences in clinical indexes among the three groups(P>0.05).After treatment,all three groups of clinical indicators improved,and the combined medication group showed more significant improvement,with statistically significant differences(P<0.05).The total effective rate of combined medication group was 92.50%,the routine group was 62.50%,the hemofiltration group was 85.00%,the difference was significant(P<0.05).After treatment,the levels of LVEDD,LVESD and BNP in the combined medication group and hemofiltration group decreased significantly(P<0.05),and the levels of LVEF improved(P<0.05),while the levels of LVEDD and LVESD in the routine group did not change significantly before and after treatment(P>0.05).After treatment,compared with the routine group,the LVEF level of the combined medication group was significantly higher,the LVEDD,LVESD and BNP levels were significantly lower,the differences were statistically significant(P<0.05).After treatment,compared with the hemofiltration group,the LVEF level of the combined medication group was higher,and the LVEDD and LVESD levels were significantly lower,the differences were statist

关 键 词：利尿剂 RAAS拮抗剂 心肾综合征 

分 类 号：R541.6[医药卫生—心血管疾病] R692[医药卫生—内科学]