连续性肾脏替代疗法治疗急性心力衰竭的临床研究

目的 观察连续性肾脏替代疗法（continuous renal replacement therapy,CRRT）治疗急性心力衰竭（acute heart failure,AHF）的临床疗效.方法 对50例我院ICU病房中急性心力衰竭患者治疗前后的血压、心率、心脏彩超、B型钠尿肽（BNP）等指标进行回顾性分析,并且比较34例患者经CRRT的治疗组和16例患者常规治疗的对照组的临床疗效.结果 两组患者在年龄、性别、APACHEII评分上无显著性差异（P＞0.05）;治疗后,治疗组患者的心率、平均动脉压、左室内径、BNP指标明显低于对照组（P＜0.05）,治疗组射血分数明显高于对照组（P＜0.01）;治疗组患者病死率（P＜0.05）、住院时间（P＜0.01）明显低于对照组;治疗组慢性肾功能不全患者经CRRT治疗后血尿素氮和肌酐均明显降低（P＜0.01）;原发病为心肌梗死的患者治疗前后各指标均无明显改善（P＞0.05）.结论 应用连续性肾脏替代疗法治疗心力衰竭患者疗效明显,但对于原发病为心肌梗死的患者,其疗效并不确定.

Clinical Study on the Treatment of Acute Heart Failure with Continuous Renal Replacement Therapy

Objective To observe the clinical effect of continuous renal replacement therapy in acute heart failure. Methods Make a retrospective analysis on blood pressure, heart rate, cardiac ultrasound, B type natriuretic peptide （BNP） and other indicators of 50 patients with acute heart failure before and after the treatment in our ICU ward, and compare the clinical efficacy between CRRT treatment group of 34 patients and control group of 16 patients with conventional treatment. Results The two groups had no significant difference in age, sex, and APACHEII score （P〉0.05）; after the treatment, heart rate, mean arterial pressure, left ventricular diameter, and the BNP index of the patients in the treatment group was significantly lower than the those of the control group （P〈0.05）, ejection fraction in treatment group was significantly higher than that of control group （P〈0.01）; The fatality rate （P〈0.05）, hospitalization time （P〈0.01） of patients in treatment group were significantly lower than that of the control group; Blood urea nitrogen and creatinine of the patients in treatment group with chronic renal insufficiency after CRRT treatment were significantly decreased （ P〈0.01 ） ; There was no significant improvement on each index for the myocardial infarction patients （P〉0,05）. Conclusion The clinical effect of continuous renal replacement therapy in acute heart failure is significant, but for myocardial infarction patients the efficacy is uncertain.