本文選題：老年人　切入點：心腎綜合征　出處：《中國全科醫(yī)學》2015年22期 　論文類型：期刊論文

【摘要】：目的探討4種不同血液凈化方式對老年I型心腎綜合征(CRS)的療效。方法選取2011年2月—2014年8月在大連醫(yī)科大學附屬第二醫(yī)院心內科及腎內科住院的老年I型CRS患者共198例,根據血液凈化治療方式分為4組,分別為單純超濾(UF)組41例、緩慢連續(xù)超濾(SCUF)組44例、間斷血液透析(IHD)組52例、連續(xù)性靜靜脈血液濾過(CVVH)組61例,檢測治療前及首次治療24 h后的理化指標及評估治療1周后的心腎功能改善情況。結果治療前4組患者血清尿素(Urea)、肌酐(SCr)、鉀(K)、鈉(Na)、B型尿鈉肽(BNP)、肌鈣蛋白(Tn-I)水平及平均動脈壓(MAP)比較,差異均無統(tǒng)計學意義(P0.05)。而治療后4組患者血清Urea、SCr、K、Na、BNP、Tn-I水平及MAP比較,差異均有統(tǒng)計學意義(P0.05);其中SCUF、IHD、CVVH組血清Urea、SCr、K、Na、BNP、Tn-I水平及MAP與UF組比較,IHD組血清K、BNP水平與SCUF組比較,CVVH組血清Urea、SCr、K、BNP、Tn-I水平與SCUF組比較,CVVH組血清Urea、SCr、BNP、Tn-I水平與IHD組比較,差異均有統(tǒng)計學意義(P0.05)。治療前4組患者左心室舒張末期內徑(LDV)、心輸出量(CO)及左心室射血分數(LVEF)、中心靜脈壓(CVP)比較,差異均無統(tǒng)計學意義(P0.05)。而治療后4組患者LDV、CO、LVEF、CVP比較,差異均有統(tǒng)計學意義(P0.05);其中SCUF、IHD組LDV、CO、LVEF、CVP與UF組比較,CVVH組LDV、CO、LVEF、CVP分別與UF、SCUF、IHD組比較,差異均有統(tǒng)計學意義(P0.05)。4組患者治療后心、腎功能改善情況比較,差異均有統(tǒng)計學意義(P0.05);其中CVVH組療效優(yōu)于UF、SCUF、IHD組,SCUF、IHD組療效亦優(yōu)于UF組,差異均有統(tǒng)計學意義(P0.05)。結論對于老年I型心腎綜合征患者,CVVH治療安全性最佳、療效最好,SCUF與IHD治療在安全性及療效上比較并無差異,UF治療安全性及療效一般,不推薦選擇。
[Abstract]:Objective to investigate the effect of four different blood purification methods on elderly patients with type I cardiorenal syndrome (CRS). Methods A total of 198 elderly patients with type I CRS were selected from February 2011 to August 2014 in Department of Cardiology and Renal Medicine, second affiliated Hospital of Dalian Medical University. According to the method of blood purification, the patients were divided into 4 groups: 41 cases in simple ultrafiltration group, 44 cases in SCUFU group, 52 cases in IHD group and 61 cases in CVVH group. Physical and chemical indexes were measured before treatment and 24 hours after the first treatment, and the improvement of cardiac and renal function was evaluated after 1 week of treatment. Results the levels of serum urea UreaI, creatinine, potassium carnitine, natriuretic natriuretic peptide type B (BNPN), cardiac troponin Tn-I (Tn-I) were measured before treatment and 24 hours after first treatment. Mean arterial pressure (MAPP), There was no significant difference (P 0.05). After treatment, the levels of Tn-I and MAP in serum of the four groups were compared. There were significant differences between the two groups (P 0.05), among which the levels of Tn-I in serum of MAP group and SCUF group were significantly higher than that of SCUF group and that of SCUF group and that of SCUF group were significantly higher than that of SCUF group and that of SCUF group and that of SCUF group were higher than those of SCUF group and that of SCUF group respectively, and that of SCUF group and SCUF group were higher than that of SCUF group and that of SCUF group and that of SCUF group were significantly higher than that of SCUF group and that of SCUF group and that of SCUF group and that of SCUF group were higher than that of SCUF group and that of SCUF group and that of SCUF group and that of SCUF group and that of SCUF group and SCUF group respectively, and there were significant differences between SCUF group and SCUF group. There was no significant difference in left ventricular end-diastolic diameter (LDV), cardiac output volume (CO), left ventricular ejection fraction (LVEFN) and central venous pressure (CVP) between the four groups before and after treatment (P 0.05), but there was no significant difference in LDVCOLVEFV CVP between the four groups after treatment. The difference was statistically significant (P 0.05), among which there were significant differences in the improvement of heart and kidney function between the patients with SCUFF IHD and the patients with CVVH and UFG SCUFIHD after treatment, and the difference between the CVP of LDVCOCOLVEFN CVP and UF group was statistically significant compared with that of CVVH group and UFG SCUFFIHD group, and there were significant differences in the improvement of heart and kidney function after treatment between SCUFU IHD group and UF group. The difference was statistically significant (P 0.05), and the curative effect of CVVH group was better than that of UF group, and the difference was statistically significant. Conclusion CVVH is the best in the treatment of elderly patients with type I cardiorenal syndrome. There is no difference in safety and efficacy between SCUF and IHD.
【作者單位】： 大連醫(yī)科大學附屬第二醫(yī)院腎內科;大連醫(yī)科大學臨床技能教研室;
【基金】：十二五國家科技支撐計劃課題(2011BAI10B08)——血液凈化質量改進和國產血液凈化產品臨床應用評價研究
【分類號】：R541.62;R692.5

【參考文獻】

相關期刊論文 前1條

1 丁紅;劉丹;周秀華;;連續(xù)性腎臟替代療法在急性心腎綜合征中的應用[J];中國老年學雜志;2011年12期

【共引文獻】

相關期刊論文 前10條

1 霍飛蛟;;連續(xù)性腎臟替代療法治療急性心腎綜合征的效果觀察[J];當代醫(yī)學;2012年36期

2 夏豪;李宸宇;方五旺;胡麗麗;;急性冠脈綜合征伴腎功能不全介入治療的臨床觀察[J];安徽醫(yī)藥;2013年12期

3 林飛;王階;;“心腎相交”在現代心血管疾病中的應用[J];中華中醫(yī)藥雜志;2014年09期

4 邊甌;馬寧;喬銳;任奕;丁亮;何瑞;;高齡男性2型心腎綜合征患者血清睪酮水平的研究[J];國際心血管病雜志;2014年05期

5 胡新民;;26例維持性血液透析患者死因分析及防治對策[J];廣西中醫(yī)藥大學學報;2014年03期

6 郭俊;馮燦;陸陽;趙仙先;;心腎綜合征的診治及研究進展[J];國際心血管病雜志;2015年01期

7 張莉;趙一俏;靳文;楊瑤琳;徐基瑛;;白細胞介素-18與Ⅱ型心腎綜合征的相關性[J];廣東醫(yī)學;2015年04期

8 梁濱;陳雨;武寶林;丁懷玉;鐘雷;黃榕，

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