CAJ | 학술논문

目的探讨重症心力衰竭合并肾功能衰竭应用全血预冲透析管路后血液灌流联合血液透析治疗后的疗效.方法选择2007年6月至2009年6月牡丹江市第一人民医院肾内科和心内一科重症心力衰竭合并肾功能衰竭患者48例.应用全血预冲透析管路后血液灌流联合血液透析治疗.每天1次,连续3 d.每次治疗前、后分别观察患者动脉血气分析(碳酸氧根离子、pH值、动脉血氧饱和度、动脉血氧分压、肾功能(血尿素氮、血肌酐)、血红蛋白、呼吸、心率、平均动脉压、中心静脉压水平.治疗前和第3次治疗后分别观察患者腩钠素、肿瘤坏死因子α水平及左室舒张未期内径、左室收缩末期内径、左室射血分数.结果治疗过程中患者生命指标和血流动力学稳定.全部患者在治疗期间无一例死亡.治疗过程中生命指征平稳,第1次治疗后呼吸、心率、血红蛋白、中心静脉压、碳酸氢根离子、pH值、动脉血氧饱和度、动脉血氧分压、血尿素氮、血肌酐指标比较差异有统计学意义(P＜0.05);平均动脉压治疗前、后比较差异无统计学意义(P＞0.05);肺部湿啰音明显减少,尿最逐渐增加.经3次治疗后脑钠素、肿瘤坏死因子α水平显著下降,左室舒张末期内径、左室收缩末期内径、左室射血分数显著改善(P＜0.01).结论血液预冲透析管路(血液灌流联合血液透析)治疗重症心力衰竭合并肾功能衰竭患者临床疗效好,安全性高.疗效观察指标容易采取且简便易行.
목적 탐토중증심력쇠갈합병신공능쇠갈응용전혈예충투석관로후혈액관류연합혈액투석치료후적료효.방법 선택2007년6월지2009년6월모단강시제일인민의원신내과화심내일과중증심력쇠갈합병신공능쇠갈환자48례.응용전혈예충투석관로후혈액관류연합혈액투석치료.매천1차,련속3 d.매차치료전、후분별관찰환자동맥혈기분석(탄산양근리자、pH치、동맥혈양포화도、동맥혈양분압、신공능(혈뇨소담、혈기항)、혈홍단백、호흡、심솔、평균동맥압、중심정맥압수평.치료전화제3차치료후분별관찰환자남납소、종류배사인자α수평급좌실서장미기내경、좌실수축말기내경、좌실사혈분수.결과 치료과정중환자생명지표화혈류동역학은정.전부환자재치료기간무일례사망.치료과정중생명지정평은,제1차치료후호흡、심솔、혈홍단백、중심정맥압、탄산경근리자、pH치、동맥혈양포화도、동맥혈양분압、혈뇨소담、혈기항지표비교차이유통계학의의(P＜0.05);평균동맥압치료전、후비교차이무통계학의의(P＞0.05);폐부습라음명현감소,뇨최축점증가.경3차치료후뇌납소、종류배사인자α수평현저하강,좌실서장말기내경、좌실수축말기내경、좌실사혈분수현저개선(P＜0.01).결론 혈액예충투석관로(혈액관류연합혈액투석)치료중증심력쇠갈합병신공능쇠갈환자림상료효호,안전성고.료효관찰지표용역채취차간편역행.
Objective To investigate the effect of Hemoperfusion(HP) treatment preconditioning whole blood for the dialyzer on the severe congestive heart failure complicated renal failure.Methods 48 congestive heart failure complicated renal failure patients were randomly selected of in-patients in Department of Nephrology and first Cardiology First People's Hospital of Mudanjiang City during June 2007-June 2009.The hemoperfusion (HP) combined with hemodialysis(HD) treatment preconditioning whole blood for the dialyzer was applicated Once a day for 3 days.Observe the changes of indexes including arterial blood gas analysis (HCO3,pH,SaO2,PaO2),renal function (BUN,Scr),respiratory (RR),heart rate (HR),mean arterial pressure (MAP),central venous pressure and brain natriuretic peptide (BNP),tumor necrosis factor-α(TGFα),hemoglobin (Hb) levels before and after treatment every day.The changes of left ventricular end-diastolic diameter (LVEDD),left ventricular end systolic diameter (LVESD),left ventricular ejection fraction (LVEF) before and after treatment were observed in echocardiography every day.Result the vital indexes and hemedynamics of patients were stable in the course of treatment.None was dead in the course of treatment. The indicators of RR,HR,Hb,central venous pressure,SaO2,arterial blood gas analysis was improved significantly (P ＞ 0.05).The patient's lung moist tales significantly reduced,urine output gradually increased.TNF-α decreased significantly after the first treatment( P ＜ 0.05).The indicators of cardiac function:LVEDD,LVESD,LVEF improved significantly after the first treatment(P ＜0.05).Conclusion Hemoperfusion (HP)combined with hemodialysis(HD)treatment preconditioning whole blood for the dialyzer on the severe congesfive heart failure complicated renal failure has a good efficacy.the treatment has high safety.observation indexes was easy to take,simple accurate.