左、右心功能不全行连续性肾脏替代治疗的疗效对比研究

摘要

目的:观察连续性肾脏替代治疗(CRRT)对左、右心功能不全的疗效并探讨其原因.方法:选择左心功能不全者46例,右心功能不全者38例,行CRRT前、后行心脏超声测定左右心室收缩末期、舒张末期内径(LVESd、RVESd,LVEDd、RVEDd)、左室射血分数(LVEF)评价心功能状态,测定血浆N端B型脑钠肽前体(NT-proBNP),肿瘤坏死因子-α(TNF-α)炎症因子水平.结果:与右心功能不全患者行CRRT后相比,左心功能不全患者术后LVESd[(52.87±1.96) mm比(45.24±1.35) mm],LVEDd[(49.37±1.14) mm比(45.95±1.06) mm],RVESd[(49.79±1.56) mm比(41.29±1.02) mm],RVEDd[(50.73±0.99) mm比(42.13±0.78) mm]均明显减小(P＜0.05或＜0.001),LVEF明显提高[(35.91±2.04)％比(46.22±2.13)％,P＜0.001],NT-proBNP[(2011.19±76.39) ng/ml比(411.59±45.31) ng/ml]、TNF-α[(491.19±16.12)比(295.49±17.05)]水平明显降低(P分别＜0.001,＜0.05),疗效有显著差异.结论:连续性肾脏替代治疗左心功能不全较右心功能不全疗效更好,可能与其对于左心功能不全能更有效清除体内过多液体水分、改善心室压力和抑制炎症有关.%Objective: To observe curative effect of continuous renal replacement therapy (CRRT) on left and right ventricular dysfunction and explore its causes. Methods: A total of 46 patients with left ventricular dysfunction and 38 patients with right ventricular dysfunction were enrolled. Echocardiography was used to measure left/right ventricular end-systolic/diastolic dimension (LVESd, RVESd, LVEDd, RVEDd) and left ventricular ejection fraction (LVEF) to evaluate cardiac status before and after CRRT. Plasma levels of N terminal pro-B type natriuretic pep-tide (NT-proBNP) and tumor necrosis factor (TNF) -α were measured. Results: Compared with patients with right ventricular dysfunction after CRRT, there were significant decrease in LVESd [(52. 87 ± 1. 96) mm vs. (45. 24 ± 1. 35) mm], LVEDd [ (49. 37 ± 1.14) mm vs. (45. 95 ± 1. 06) mm], RVESd [ (49. 79 ± 1. 56) mm vs. (41. 29 ± 1.02) mm], RVEDd [ (50. 73±0.99) mm vs. (42. 13 ± 0. 78) mm], levels of NT-proBNP [ (2011.19 ± 76. 39) ng/ ml vs. (411.59±45.31) ng/ml] and TNF-α [ (491. 19 ± 16. 12) vs. (295.49±17.05)] (P<0. 05 or <0. 001), and significant increase in LVEF [ (35. 91 ± 2. 04) % vs. (46. 22 ± 2.13) %, P<0. 001] in patients with left ventricular dysfunction after CRRT. There was significant difference on curative effect between two groups. Conclusion: Compared with right ventricular dysfunction, CRRT possesses better curative effects on left ventricular dysfunction, which may be related with that CRRT can more remove excessive liquid water, improve ventricular pressure and inhibit inflammation for left ventricular dysfunction.