全血预冲血液灌流联合血液透析治疗重症心力衰竭合并肾功能衰竭患者的临床研究

目的 探讨重症心力衰竭合并肾功能衰竭应用全血预冲透析管路后血液灌流联合血液透析治疗后的疗效.方法 选择2007年6月至2009年6月牡丹江市第一人民医院肾内科和心内一科重症心力衰竭合并肾功能衰竭患者48例.应用全血预冲透析管路后血液灌流联合血液透析治疗.每天1次,连续3 d.每次治疗前、后分别观察患者动脉血气分析(碳酸氧根离子、pH值、动脉血氧饱和度、动脉血氧分压、肾功能(血尿素氮、血肌酐)、血红蛋白、呼吸、心率、平均动脉压、中心静脉压水平.治疗前和第3次治疗后分别观察患者腩钠素、肿瘤坏死因子α水平及左室舒张未期内径、左室收缩末期内径、左室射血分数.结果 治疗过程中患者生命指标和血流动力学稳定.全部患者在治疗期间无一例死亡.治疗过程中生命指征平稳,第1次治疗后呼吸、心率、血红蛋白、中心静脉压、碳酸氢根离子、pH值、动脉血氧饱和度、动脉血氧分压、血尿素氮、血肌酐指标比较差异有统计学意义(P＜0.05);平均动脉压治疗前、后比较差异无统计学意义(P＞0.05);肺部湿啰音明显减少,尿最逐渐增加.经3次治疗后脑钠素、肿瘤坏死因子α水平显著下降,左室舒张末期内径、左室收缩末期内径、左室射血分数显著改善(P＜0.01).结论 血液预冲透析管路(血液灌流联合血液透析)治疗重症心力衰竭合并肾功能衰竭患者临床疗效好,安全性高.疗效观察指标容易采取且简便易行.

The clinical research in hemoperfusion combined with hemodialysis treatment pre-rinsing with whole blood for the dialyzer on patients with congestive heart failure complicated renal failure

Objective To investigate the effect of Hemoperfusion(HP) treatment preconditioning whole blood for the dialyzer on the severe congestive heart failure complicated renal failure.Methods 48 congestive heart failure complicated renal failure patients were randomly selected of in-patients in Department of Nephrology and first Cardiology First People's Hospital of Mudanjiang City during June 2007-June 2009.The hemoperfusion (HP) combined with hemodialysis(HD) treatment preconditioning whole blood for the dialyzer was applicated Once a day for 3 days.Observe the changes of indexes including arterial blood gas analysis (HCO3,pH,SaO2,PaO2),renal function (BUN,Scr),respiratory (RR),heart rate (HR),mean arterial pressure (MAP),central venous pressure and brain natriuretic peptide (BNP),tumor necrosis factor-α(TGFα),hemoglobin (Hb) levels before and after treatment every day.The changes of left ventricular end-diastolic diameter (LVEDD),left ventricular end systolic diameter (LVESD),left ventricular ejection fraction (LVEF) before and after treatment were observed in echocardiography every day.Result the vital indexes and hemedynamics of patients were stable in the course of treatment.None was dead in the course of treatment. The indicators of RR,HR,Hb,central venous pressure,SaO2,arterial blood gas analysis was improved significantly (P ＞ 0.05).The patient's lung moist tales significantly reduced,urine output gradually increased.TNF-α decreased significantly after the first treatment( P ＜ 0.05).The indicators of cardiac function:LVEDD,LVESD,LVEF improved significantly after the first treatment(P ＜0.05).Conclusion Hemoperfusion (HP)combined with hemodialysis(HD)treatment preconditioning whole blood for the dialyzer on the severe congesfive heart failure complicated renal failure has a good efficacy.the treatment has high safety.observation indexes was easy to take,simple accurate.