急性左心衰竭合并肾功能不全床旁血液超滤治疗作用评价

 目的 评价床旁血液超滤治疗在抢救急性左心衰竭合并肾功能不全患者中的作用.方法 将106例急性左心衰合并肾功能不全患者根据治疗策略分为常规治疗组和超滤组,所有患者入院时均监测心率、呼吸、血压、中心静脉压,检测肾功能、动脉血气.入院24 h内行心脏彩超检查,并记录患者症状缓解时间,出院前再次检测心脏彩超.结果 基线超滤组收缩压、舒张压和中心静脉压明显高于常规组(P<0.01或P<0.05),PaO2超滤组明显低于常规组(P<0.05),超滤组BUN、Cr高于常规组(P<0.01).症状缓解时两组肾功能比较无统计学差异,心脏彩超显示超滤组LVESD、LVEDD明显高于常规组(P<0.01),而EF(%)明显低于常规组(P<0.05),超滤组症状缓解时间明显少于常规组(P<0.05).在出院时心脏彩超显示超滤组LVESD、LVEDD、EF两组无明显差异,两组的住院死亡人数无差异,但超滤组可以明显减少住院时间(P<0.05).结论 床旁血液超滤治疗在抢救急性左心衰竭合并肾功能不全重症患者中较常规治疗更有效.

Effects of bedside hemo-ultrafiltration on patients with acute left ventricular failure complicated by renal insufficiency

Objective To investigate the effects of bedside hemo- tdtrafdtration on patients with acute left ventricular failure complicated by renal imuificiency. Methods According to therapeutic strategy, 106 patients with heart failure complicated by renal imufficiency were assigned to conventional therapy group and ultrafiltration therapy group. All the patients were monitored for heart rate, respiration, blood pressure, central venom pressure, blood BUN, Cr and arterial blood gas. Heart color Ultrasound was performed in 24 hours after admission and prior to discharge. Results The patients＇ systolic blood pressure, diastolic blood pressure, central venom pressure, BUN and Cr in ultrafiltration therapy group were higher than those in conventional therapy group, but PaO2 was lower in baseline. When symptoms were relieved, there was no difference in BUN and Cr between the two groups, but LVESD and LVEDD were higher in ultrafiltration therapy group and EF was lower in conventional therapy group. The time for attaining symptomatic relief in ultmf＇dtration therapy group was shorter than in conventional therapy group. There were no differences between the two groups in LVESD, LVEDD, EF, and number of deaths but ulttafiltration therapy group had shorter hospital stay. Coladusions Bedside hemo - ultrafdtration is more eificacious than conventional therapy in treating heart failure complicated by renal insufficiency.