摘要
目的探讨连续低效每日透析滤过(SLEDD-f)治疗顽固性心力衰竭合并肾功能不全的疗效及安全性。方法选择2008年2月—2011年7月在我院住院的46例顽固性心力衰竭合并肾功能不全患者,按照随机数字表将患者分为观察组和对照组,每组23例,对照组行连续性静脉-静脉血液滤过(CVVH)治疗,观察组行SLEDD-f治疗,比较两组患者治疗前后美国心脏病协会(NYHA)心功能分级、心功能〔左室舒张末期内径(LVEDd)、左室射血分数(LVEF)、心排出量(CO)〕、肾功能〔血清肌酐(Scr)、尿素氮(BUN)〕的变化及肝素用量、单次治疗时间、总治疗时间、血液净化治疗的并发症、治疗费用。结果两组患者经治疗后临床症状均明显改善,治疗后两组患者NYHA心功能分级、LVEDd、LVEF、心排出量、Scr、BUN较治疗前均明显改善(P<0.05),但组间比较差异均无统计学意义(P>0.05)。观察组患者的出血并发症更少(2.8%与15.4%,P<0.01),肝素用量更少〔(4.1±0.9)kU与(7.2±1.7)kU,P<0.01〕,治疗费用更低〔(2.14±0.36)万元与(3.75±0.99)万元,P<0.01〕。结论SLEDD-f能平稳清除患者体内水及毒素,并保持血流动力学稳定,疗效与CVVH相当,但肝素用量更少,治疗费用更低,可以作为CVVH的替代治疗,更适合基层医院开展。
Objective To investigate the effect of sustained low-efficiency daily diafiltration（SLEDD-f） in patients with refractoriness heart failure and renal insufficiency.Methods Forty-six patients with refractoriness heart failure with renal insufficiency,admitted to this hospital from February 2008 to July 2011,were divided randomly into groups observation and control,23 in each.Control group underwent CVVH,observation group SLEDD-f.New York Heart Association（NYHA） grading,cardiac function（left ventricular end-diastolic diameter（LVEDd）,left ventricular ejection fraction（LVEF）,cardiac output（CO）） and renal function（serum creatinine（Scr）,blood urea nitrogen（BUN））,heparin dose,single treatment time,total treatment time,complications of blood purification therapy and cost of treatment were compared between 2 groups before and after treatment.Results Clinical symptoms,NYHA grading,LVEDd,LVEF,CO,BUN,Scr were obviously improved in 2 groups after treatment（P〈0.05）,but there was not significant difference between them（P〉0.05）.Observation group had heparin doses（（4.1±0.9）vs（7.2±1.7） Kilounit,P〈0.01）,fewer hemorrhage complications（2.8% vs 15.4%,P〈0.01） and less cost（（37.5±9.9）vs（21.4±3.6） thousand yuan,P〈0.01）.Conclusion SLEDD-f,which can keep hemodynamics stable during removing excess water and toxin,is effective and safe in treatment of refractory heart failure with renal insufficiency.
出处
《中国全科医学》
CAS
CSCD
北大核心
2012年第20期2347-2349,共3页
Chinese General Practice
关键词
连续低效每日透析滤过
连续性肾脏替代治疗
心力衰竭
肾功能不全
Sustained low-efficiency daily diafiltration； Continuous renal replacement treatment（CRRT）； Heart failure； Renal insufficiency
