连续性与间歇性血液滤过治疗Ⅰ型心肾综合征的临床研究

目的 对比连续性静脉-静脉血液滤过(continous veno-venous hemofiltration,CVVH)与间歇性血液滤过(intermittent hemofiltration, IHF)治疗对Ⅰ型心肾综合征患者血流动力学及临床预后的影响。方法 收集2008年5月至2011年6月在我院接受CVVH或IHF治疗的Ⅰ型心肾综合征患者资料,共34例,19例为CVVH治疗,15例为IHF治疗。分析患者一般资料,治疗前后心率、血压变化及透析治疗后28 d生存情况。结果 CVVH与IHF组患者治疗前后心率、舒张压差异均无统计学意义(P>0.05)；两组患者治疗前收缩压差异也无统计学意义(P>0.05),但IHF组治疗后收缩压低于CVVH组(P<0.05)；治疗后48 h,CVVH与IHF组最大平均压、血压波动差异均无统计学意义(P>0.05),但IHF组最低平均压低于CVVH组(P<0.05)。CVVH组和IHF组患者心功能改善情况、28 d病死率差异均无统计学意义(P>0.05)。多因素分析显示,APACHE Ⅱ分值是患者死亡的主要影响因素；APACHE Ⅱ分值、单位时间内净超滤量是最低平均压的主要影响因素。结论 与IHF相比,CVVH治疗Ⅰ型心肾综合征未能明显降低病死率。Ⅰ型心肾综合征患者生存和血流动力学的主要影响因素均是患者病情的严重程度。

Continuous veno-venous hemofiltration and intermittent hemofiltration in treatment of type 1 cardiorenal syndrome: a clinical research

Objective To compare the effects of continuous veno-venous hemofiltration(CVVH)and intermittent hemofiltration(IHF) on the hemodynamics and clinical outcomes of patients with type 1 cardiorenal syndrome.Methods From May 2008 to June 2011,34 patients diagnosed with type 1 cardiorenal syndrome were admitted to our hospital and received CVVH(19 cases) or IHF(15 cases).The general data,acute hemodynamic changes before and after hemofiltration and clinical outcomes at 28 days after hemofiltration were evaluated.Results There were no significant differences in the heart rates,diastolic blood pressure between the two groups before and after hemofiltration(P>0.05).The systolic pressure was similar between the two groups before hemofiltration(P>0.05),but that in the IHF group was significantly lower than that in the CVVH group after hemofiltration(P<0.05).No significant difference was found in the maximal mean pressure or blood pressure changes between the two groups at 48 h after hemofiltration(P>0.05),but the minimal mean pressure in IHF group was significantly lower than that in the CVVH group(P<0.05).The improvement of cardiac function and the mortality rates at 28 d after hemofiltration were not significantly different between the two groups(P>0.05).Multivariate analysis suggested that APACHE Ⅱ was the main influence factor of 28-day mortality of patients,and APACHE Ⅱ and net ultrafiltration were the main influence factor of the minimal mean pressure.Conclusion Compared with IHF,CVVH fails to greatly reduce the mortality of patients with type 1 cardiorenal syndrome.The severity of the disease is the main influence factor for the hemodynamic changes and the 28-day mortality of patients with type 1 cardiorenal syndrome.