| 床旁血滤、无创通气联合新活素对治疗终末期心力衰竭的疗效 |
| 投稿时间：2017-06-15 修订日期：2017-07-26 点此下载全文 |
| 引用本文：李旭蕊,王霞,阎香娟,李颖义,秦连菊,梁小华.床旁血滤、无创通气联合新活素对治疗终末期心力衰竭的疗效[J].医学研究杂志,2018,47(4):65-68 |
| DOI：
10.11969/j.issn.1673-548X.2018.04.017 |
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| 基金项目:河北省卫生厅科研基金资助项目（ZL20140273） |
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| 中文摘要:目的 应用床旁血滤、无创通气联合新活素对治疗终末期心力衰竭的临床疗效观察。方法 选取笔者医院重症医学科及心血管内科于2012年7月~2015年7月收治的52例难治性终末期心力衰竭患者，将其分为3组，A组为14例常规应用利尿剂及无创通气；B组19例应用床旁血滤和无创通气治疗；C组19例应用床旁血滤、无创通气和新活素治疗，观察治疗前和治疗72h后血浆NT-Pro-BNP浓度、血肌酐浓度，行床旁心脏彩色超声测定左心室射血分数（LVEF）及临床症状体征疗效的变化情况。结果 3组患者中治疗前后NT-Pro-BNP浓度有不同程度的下降差异有统计学意义（P<0.05），C组NT-Pro-BNP浓度下降程度优于A组和B组，差异有统计学意义（P<0.05）；3组患者血肌酐值治疗前后A组下降差异无统计学意义（P>0.05），B组和C组治疗后血肌酐明显下降分别与A组比较，差异有统计学意义（P<0.05），但B组和C组两组比较，差异无统计学意义（P>0.05）；LVEF值在3组患者中治疗前后均有升高，差异有统计学意义（P<0.05），其中C组升高最为明显，差异有统计学意义（P<0.05）；脱机时间C组最短优于B组、A组差异有统计学差异（P<0.05），应用升压药物时间B组和C组均短于A组，差异有统计学意义（P<0.05），但B组和C组比较，差异无统计学意义（P>0.05）；根据疗效判定标准显示A组、B组和C组总有效率分别为57.14%、78.94%和89.47%，3组间比较差异有统计学意义（P<0.05），C组改善临床症状体征最明显有统计学意义（P<0.05）。结论 床旁血滤、无创通气联合新活素治疗终末期难治性性合并低血压、肾衰竭患者时短期内存在良好的临床疗效。 |
| 中文关键词:床旁血滤 无创通气 新活素 终末期难治性心力衰竭 射血分数 NT-Pro-BNP |
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| Continuous Renal RePlacement TheraPy(CRRT), Noninvasive Ventilation Combined LyoPhilized Recombinant Human Brain Natriuretic PePtide in Treatment of Refractory End Stage Heart Failure |
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| Abstract:Objective To explore the clinical effect of treating of refractory end stage heart failure with CRRT, noninvasive ventilation and lyophilized recombinant human brain natriuretic peptide. Methods Fifty-two cases of patients of Refractory end stage heart failure in ICU and cardiology, from July 2012 to July 2015, were randomly divided into three groups. There were 14 cases patients of being treated with diuretic and noninvasive ventilation in group A. There were 19 cases patients of being treated with CRRT and noninvasive ventilation in group B. There were 19 cases patients of being treated with CRRT, noninvasive ventilation and lyophilized recombinant human brain Natriuretic peptide in group C.We compared three groups of patients before and after 72h treatment the concentration of plasma NT-pro-BNP and serum creatinine, left ventricular ejection fraction (LVEF), the changes of the curative effect of clinical symptoms and signs. Results Compared with before and after treatment of three groups,the concentration of NT-Pro-BNP were declined.They were statistically difference (P<0.05). The concentration of NT-Pro-BNP of group C was lower than that of group A and group B, they were statistically significant (P<0.05). The concentration of serum creatinine of three groups of patients in before and after treatment,the decline valuse of group A was no statistical difference (P>0.05),but that of group B and group C were obviously decreased,respectively compared with group A, they were statistically significant (P<0.05),that of group B and group C no difference (P>0.05). LVEF value in three groups ofpPatients in before treatment were higher than in after treatment,they were statistical significance (P<0.05). The time of weaning from mechanical ventilation in group C is shortest,it was better than that of group B and group A,statistically significant (P<0.05). The time of the application of booster drugs time in group B and group C were shorter than that of group A, statistical significance (P<0.05), but no obvious difference was found between group B and C group (P>0.05).According to the curative standard display in group A, group B and group C total effective rate were 57.14%, 78.94% and 89.47%, the comparison between groups was statistically significant (P<0.05), group C most obviously improve the clinical symptoms and signs was statistically significant (P<0.05). Conclusion Continuous renal replacement therapy(CRRT), noninvasive ventilation combined treatment of refractory end stage heart failure with shock, renal failure of lyophilized recombinant human brain natriuretic peptide is a good clinical effect. |
| keywords:Continuous renal replacement therapy(CRRT) Noninvasive ventilation Lyophilized recombinant human brain natriuretic peptide Refractory end stage heart failure LVEF NT-Pro-BNP |
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