CAJ | 학술논문

目的探讨尿毒症顽固性中重度心功能衰竭患者的治疗方法及影响因素.方法采用自身对照研究方法,观察30例尿毒症顽固性中重度心功能衰竭行维持性血液透析(MHD)患者在常规综合治疗基础上加用血必净注射液治疗后的微炎症状态,心脏左室收缩功能改善情况,建立预测改善量的多元线性回归模型,并观察血必净注射液总剂量与C-反应蛋白改善量(△CRP)的相关性.结果治疗后左室射血分数(LVEF)、短缩分数(FS)、每搏量(SV,ml)均较治疗前明显改善[LVEF:0.42±0.07比0.34±0.04,FS:(21.07±3.83)％比(16.33±2.43)％,SV:66.83±7.00比52.20±7.62,均P＜0.01]；治疗前后心排血量(CO,L/min)比较差异无统计学意义(4.77±0.65比4.49±0.68,P＞0.05).预测左室收缩功能各指标改善量的因素主要有年龄、△CRP、血红蛋白改善量(△Hb)、血必净注射液总剂量、HCO3-改善量(△HCO3-)、血肌酐改善量(△SCr)及治疗后Hb、CRP等,以△LVEF、△FS、△SV为因变量的回归模型中,各预测因素的种类及权重略有所差别,但模型拟合度高.血必净注射液总剂量与△CRP呈显著正相关(r=0.561,P=0.001).结论血必净注射液通过改善微炎症状态,可有效改善尿毒症患者心功能,且呈量效关系；心功能的改善还与年龄、△Hb、治疗后Hb、酸中毒的纠正及透析充分性有关.
목적 탐토뇨독증완고성중중도심공능쇠갈환자적치료방법급영향인소.방법 채용자신대조연구방법,관찰30례뇨독증완고성중중도심공능쇠갈행유지성혈액투석(MHD)환자재상규종합치료기출상가용혈필정주사액치료후적미염증상태,심장좌실수축공능개선정황,건립예측개선량적다원선성회귀모형,병관찰혈필정주사액총제량여C-반응단백개선량(△CRP)적상관성.결과 치료후좌실사혈분수(LVEF)、단축분수(FS)、매박량(SV,ml)균교치료전명현개선[LVEF:0.42±0.07비0.34±0.04,FS:(21.07±3.83)％비(16.33±2.43)％,SV:66.83±7.00비52.20±7.62,균P＜0.01]；치료전후심배혈량(CO,L/min)비교차이무통계학의의(4.77±0.65비4.49±0.68,P＞0.05).예측좌실수축공능각지표개선량적인소주요유년령、△CRP、혈홍단백개선량(△Hb)、혈필정주사액총제량、HCO3-개선량(△HCO3-)、혈기항개선량(△SCr)급치료후Hb、CRP등,이△LVEF、△FS、△SV위인변량적회귀모형중,각예측인소적충류급권중략유소차별,단모형의합도고.혈필정주사액총제량여△CRP정현저정상관(r=0.561,P=0.001).결론 혈필정주사액통과개선미염증상태,가유효개선뇨독증환자심공능,차정량효관계；심공능적개선환여년령、△Hb、치료후Hb、산중독적규정급투석충분성유관.
Objective To investigate the therapeutic strategies and prognostic factors of refractory medium-severe heart failure in uremic patients.Methods A single center,self control clinical research was conducted,and the data consisted of 30 uremic patients with refractory medium-severe heart failure undergoing maintenance hemodialysis (MHD),who received routine combined modality therapy and Xuebijing injection (to modify micro-inflammation).The systolic function of the left ventricle was compared before and after therapy.Multiple linear regression models were established to predict the improvements of systolic function of ventricle.Relationship between the accumulated dose of Xuebijing injection and changes of C-reactive protein (△CRP) was observed.Results The values of left ventricle ejection fraction (LVEF),fractional shortening (FS),and stroke volume (SV,ml) after therapy were improved compared with those before therapy [LVEF:0.42 ± 0.07 vs.0.34 ± 0.04,FS:(21.07 ± 3.83)％ vs.(16.33 ±2.43)％,SV:66.83 ± 7.00 vs.52.20 ± 7.62,all P＜0.01].In terms of cardiac output (CO,L/min),there was no statistical difference before and after therapy (4.77 ± 0.65 vs.4.49 ± 0.68,P＞0.05).In the multiple linear regression models of △LVEF,△FS and △SV,the independent variables that affect dependent variables included age,△CRP,changes of hemoglobin (△Hb),accumulated dose of Xuebijing injection,changes of HCO3-(△HCO3-),changes of serum creatinine (△SCr),Hb and CRP after therapy,the factors and weights of which had slight variation on accordance with different dependent variables.There was significant positive correlation between accumulated dose of Xuebijing injection and △CRP (r=0.561,P=0.001).Conclusions Xuebijing injection can improve heart function in uremic patients by modifying micro-inflammation,whose accumulated dose and therapeutic effect show positive correlation.In addition the improvement of heart failure has something to do with age,△Hb,Hb after therapy,the correction of acidosis and dialysis sufficiency.