摘要
目的观察浅低温持续肾脏替代治疗(CRRT/MHT)用于心血管外科术后急性严重左心功能不全的效果及安全性。方法纳入2007年1月-2015年1月阜外医院心脏及大血管外科术后入住ICU、发生严重急性左心功能不全的患者26例作为CRRT/MHT组;应用EuroScoreⅡ评分进行一对一配对选取同期因心脏术后严重急性左心功能不全入住ICU行ECMO辅助治疗的患者26例作为对照组。采用全自动床旁连续血滤系统进行CRRT,控制患者中心血温34℃,同时末梢保温;减少容量负荷;维持平均动脉压(MAP)60~70 mmHg,维持心排指数(CI)>1.5 L/(min·m2)。心功能好转后逐步恢复中心血温,增加血管活性药,恢复容量负荷并停用CRRT。观察CRRT/MHT治疗前后患者中心血温、肺动脉楔压、MAP、CI变化情况,以及正性肌力药、缩血管药物用量;比较CRRT/MHT组与ECMO组支持治疗时间、成功脱机率、ICU及在院存活率、存活患者ICU时间及住院时间等。结果 CRRT/MHT组治疗期间中心血温维持在(34.0±0.5)℃。肺动脉楔压、MAP、CI以及正性肌力药、缩血管药物用量在CRRT/MHT期间均明显下降(P<0.01)。心功能在CRRT/MHT后第5天逐渐恢复。CRRT/MHT组与ECMO组支持治疗时间[(152.5±25.3) h vs.(133.7±27.3) h]、成功脱机率(73.1%vs. 61.5%)、ICU生存率(73.1%vs. 61.5%)、在院生存率(69.2%vs. 57.7%)、存活患者ICU时间[(28±11) d vs.(31±13) d]、住院时间[(55±16) dvs.(59±16) d]差异均无统计学意义(P>0.05)。CRRT/MHT组无严重并发症发生。结论 CRRT/MHT用于心血管外科术后急性严重左心功能不全的效果可靠,安全性高。
Objective To explore the effect of continuous renal replacement therapy(CRRT) combined with mild hypothermia(MHT) on acute severe heart failure after cardiovascular surgery. Methods A retrospective analysis was performed of 26 patients who were treated from January 2007 to January 2015 with the combined therapy of CRRT and MHT(CRRT/MHT). Core temperature was reduced to 34 ℃. The doses of inotropes and vasopressors decreased. Mean arterial pressure(MAP)was maintained at 60-70 mmHg and cardiac index(CI)>1.5 L/(min·m2). When cardiac function was improved core temperature was recovered gradually. The dose of inotropes and the volume load increased, and the CRRT was discontinued. Comparison of outcomes was made with a matched historic ECMO control group. The core body temperature, pulmonary arterial wedge pressure, mean arterial pressure, cardiac index, the doses of inotropes and vasopressors, mean arterial pressure and cardiac index were observed and recorded. The time for supportive treatment, successful off-line rate, ICU time and hospital stay, and the survival rate during the ICU and hospital stay were compared between two groups. Results Core body temperature was maintained at(34.0±0.5)℃ during the combined therapy;Pulmonary arterial wedge pressure, the doses of inotropes and vasopressors, MAP and CI substantially decreased during the combined therapy(P<0.01);and cardiac function recovered at about the fifth day of treatmentin the study group. The total support time was [(152.5±25.3) h vs.(133.7±27.3) h], successful wean rate(73.1% vs. 61.5%), ICU survival rate(73.1% vs. 61.5%), hospital survivial rate(69.2% vs. 57.7%), ICU length of stay [(28±11) days vs.(31±13) days] and hospital length of stay [(55±16) days vs.(59±16) days] without stastical significance between CRRT/MHT group and ECMO group(P>0.05). There were no major complications in CRRT/MHT group. Conclusions These findings suggest that patients with acute severe heart failure after cardiovascular surgery can benefit from a strategy of CRRT/MHT. The results have given us new insight into the treatment of these patients.
作者
杜雨
张永辉
周宏艳
曹芳芳
王冀
张海涛
DU Yu;ZHANG Yong-hui;ZHOU Hong-yan;CAO Fang-fang;WANG Ji;ZHANG Hai-tao(Department of Surgical Intensive Care Unit,Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2019年第5期412-417,共6页
Medical Journal of Chinese People's Liberation Army
基金
深圳市三名工程(2016-SZZF02)~~
关键词
浅低温
持续肾脏替代治疗
左心功能不全
血流动力学
mild hypothermia
continuous renal replacement therapy
left heart failure
hemodynamic
