连续性肾脏替代治疗老年心肾综合征患者临床疗效观察

摘要

目的：观察连续性肾脏替代治疗对老年心肾综合征（ CRS）患者的临床疗效。方法选择老年CRS （I型）患者117例，按随机数字表法分为观察组（58例）与对照组（59例），对照组患者给予常规内科药物治疗，观察组在对照组治疗基础上加用连续性肾脏替代治疗。分别于治疗前及治疗后24 h检测并比较心肾功能及炎性因子等指标。结果治疗前，2组患者平均动脉压（ MAP）、心率（ HR）、APACHE II评分比较差异无统计学意义（ P ＞0ø．05）；治疗24 h后，2组患者尿中性粒细胞明胶酶相关脂质转运载蛋白（ NGAL）以及血清CK-MB、cTnT、BNP、SCr、胱抑素-C （Cys-C）、TNF-α、CRP、IL-6水平较治疗前降低，且观察组优于对照组（ P ＜0．05）。观察组24 h MAP、72 h日均尿量（ ml／d）较对照组明显上升，HR、APACHE II评分、7日内气管插管率及临床病死率较对照组下降，2组比较差异均有统计学意义（ P ＜0．05）。结论连续性肾脏替代治疗能有效缓解心脏负荷，减少肾脏损伤，稳定生命体征，减少临床病死率。%Objective To observe the clinical effect of continuous renal replacement therapy in elderly patients with cardiac and renal syndrome (CRS).Methods One hundred and seventeen cases of elderly patients with CRS (type I) were randomly divided into observation group (58 cases) and control group (59 cases).The control group was treated with routine medicine treatment .The observation group was treated with continuous renal replacement therapy on the basis of control group.24 h before and after treatment , heart and kidney function , inflammatory factor were detected and compared between the two groups .Results Before treatment , the two groups of patients ’ mean arterial pressure ( MAP ) , heart rate ( HR ) , APACHE II score’s difference showed no statistical significance ( P >0.05);24 h after treatment, 2 groups of patients’ uri-nary neutrophil gelatinase-associated lipid transfer protein (NGAL), serum CK-MB, cTnT, BNP, serum creatinine, cystatin C (Cys-C), TNF alpha, CRP, IL-6 levels were decreased compared with those before treatment , and the observation group was better than the control group ( P <0.05).Observation group’s 24 h MAP, 72 h average daily urine volume (ml/d) were increased obviously compared with the control group , HR, APACHE II score, 7 day’s endotracheal intubation rate and clinical fatality rate decreased compared with the control group , 2 group ’ s differences were statistically significant ( P <0.05).Conclusion Continuous renal replacement therapy can effectively relieve cardiac load , reduce kidney damage , stable vital signs, reduce the clinical mortality.