不同血液净化方式对尿毒症并发心力衰竭病人疗效及心肌酶水平的影响
|
摘要
目的比较血液透析(HD)和血液透析联合灌流(HP+HD)两种不同的血液净化方式对尿毒症并发心力衰竭病人疗效及心肌酶水平的影响。方法选择2013年1月—2016年1月我院肾病风湿科收治的尿毒症并发心力衰竭病人120例,按照透析方法不同分为HD组(58例)和HP+HD组(62例)。对两组病人治疗前及治疗1、3个月后的肌酸磷酸激酶(CK)、乳酸脱氢酶(LDH)、羟丁酸脱氢酶(HBDH)水平,治疗后心功能改善情况及出院后1年生存率进行统计学分析。结果治疗后,HP+HD组的CK、LDH、HBDH水平均显著低于HD组(t=2.67~7.18,P<0.05);HP+HD组的心率、收缩压、舒张压、NYHA分级、超滤量、低血压发生率与HD组比较,差异均有统计学意义(t=17.66~149.61,χ~2=7.39,P<0.01)。两组病人1年生存率比较,差异无统计学意义(P>0.05)。结论 HP+HD较单纯的HD能更有效地降低尿毒症并发心力衰竭病人的心肌酶学指标,改善心功能及血流动力学水平,提高临床治疗效果。
Objective To investigate the effect of two different blood purification methods,hemodialysis(HD)and hemoperfusion(HP)+HD,on the outcome of patients with uremia complicated by heart failure and their effects on myocardial enzyme levels. Methods A total of 120 patients with uremia complicated by heart failure who were admitted to Department of Nephrology in our hospital from January 2013 to January 2016 were enrolled and divided into HD group with 58 patients and HP+HD group with 62 patients according to the dialysis method.A statistical analysis was performed for the levels of creatine kinase(CK),lactate dehydrogenase(LDH),and hydroxybutyrate dehydrogenase(HBDH)before treatment and after 1 and 3 months of treatment,improvement in cardiac function after treatment,and 1-year survival rate. Results After treatment,the HP+HD group had significantly lower levels of CK,LDH,and HBDH than the HD group(t=2.67-7.18,P<0.05).There were significant differences between the two groups in heart rate,systolic pressure,diastolic pressure,NYHA classification,ultrafiltration volume,and incidence rate of hypotension(t=17.66-149.61,χ~2=7.39,P<0.01).There was no significant difference in 1-year survival rate between the two groups(P>0.05). Conclusion Compared with HD,HP+HD can reduce myocardial enzyme levels and improve cardiac function,hemodynamic parameters,and clinical outcome more effectively in patients with uremia complicated by heart failure.
Objective To investigate the effect of two different blood purification methods,hemodialysis(HD)and hemoperfusion(HP)+HD,on the outcome of patients with uremia complicated by heart failure and their effects on myocardial enzyme levels. Methods A total of 120 patients with uremia complicated by heart failure who were admitted to Department of Nephrology in our hospital from January 2013 to January 2016 were enrolled and divided into HD group with 58 patients and HP+HD group with 62 patients according to the dialysis method.A statistical analysis was performed for the levels of creatine kinase(CK),lactate dehydrogenase(LDH),and hydroxybutyrate dehydrogenase(HBDH)before treatment and after 1 and 3 months of treatment,improvement in cardiac function after treatment,and 1-year survival rate. Results After treatment,the HP+HD group had significantly lower levels of CK,LDH,and HBDH than the HD group(t=2.67-7.18,P<0.05).There were significant differences between the two groups in heart rate,systolic pressure,diastolic pressure,NYHA classification,ultrafiltration volume,and incidence rate of hypotension(t=17.66-149.61,χ~2=7.39,P<0.01).There was no significant difference in 1-year survival rate between the two groups(P>0.05). Conclusion Compared with HD,HP+HD can reduce myocardial enzyme levels and improve cardiac function,hemodynamic parameters,and clinical outcome more effectively in patients with uremia complicated by heart failure.
引文
[1]陈玉琼,王娟,方华,等.高通量血液透析与常规血液透析对慢性肾功能衰竭尿毒症期患者的疗效比较[J].疑难病杂志,2015,14(9):932-935.
[2]YAMAMOTO S,KAZAMA J J,WAKAMATSU T.Removal of uremic toxins by renal replacement therapies:a review of current progress and future perspectives[J].Renal Replacement Therapy,2016,2(1):1-8.
[3]SELK N,RODBY R A.Unexpectedly severe metabolic acidosis associated with sodium thiosulfate therapy in a patient with calcific uremic arteriolopathy[J].Seminars in Dialysis,2011,24(1):85-88.
[4]聂凌,杨惠标.尿毒症心脏病变的研究进展[J].国外医学(泌尿系统分册),2004,24(3):408-412.
[5]盛斌,蔡启德,尹良红.尿毒症心脏损害的机制与研究进展[J].中国病理生理杂志,2003,19(5):712-716.
[6]卢光娅,谭若芸.不同血流量血液灌流联合血液透析治疗尿毒症的临床疗效观察[J].临床和实验医学杂志,2016,15(1):6-8.
[7]ANDERSEN P T,NIELSEN L K,CHRISTENSEN K S.Transcutaneous oxygen tension during hemodialysis in uremic patients with reduced cutaneous blood perfusion[J].Surgery,1988,104(3):584-587.
[8]REGOLISTI G,MAGGIORE U,CADEMARTIRI C A,et al.Cerebral perfusion during intermittent hemodialysis in patients with acute kidney injury and advanced liver cirrhosis[J].Journal of Nephrology,2013,26(4):771-777.
[9]韦秀芳,阮素莲,谢兴文.慢性肾功能衰竭行维持血液透析患者死亡原因及其影响因素分析[J].实用临床医药杂志,2016,20(3):160-161.
[10]成栋,周华虹,郎旭军,等.慢性肾衰竭血液透析患者泌尿系感染相关因素分析[J].中华医院感染学杂志,2017,27(5):1007-1010.
[11]杨亮.老年尿毒症病人血液透析诱导期心血管并发症的预防与护理[J].国际心血管病杂志,2017,44(A01):257-258.
[12]李有跃,谭光林,郭峰.生脉胶囊治疗尿毒症慢性心力衰竭疗效观察[J].西部医学,2015,27(9):1349-1351.
[13]杨成林,郑忠爱,肖斌,等.血液透析对难治性心力衰竭合并尿毒症患者血液生化指标和心功能的影响[J].医学综述,2016,22(7):1412-1414.
[14]张颖莹,张昆,王爱丽,等.RAAS对血液透析患者透析过程中血压波动的影响及相关因素分析[J].中国血液净化,2016,15(10):545-549.
[15]陆建洪,翁少翔,张树鑫,等.心力衰竭患者肺部感染血清细胞因子水平与心肌酶谱的变化研究[J].中华医院感染学杂志,2015,25(24):5618-5619,5636.
[2]YAMAMOTO S,KAZAMA J J,WAKAMATSU T.Removal of uremic toxins by renal replacement therapies:a review of current progress and future perspectives[J].Renal Replacement Therapy,2016,2(1):1-8.
[3]SELK N,RODBY R A.Unexpectedly severe metabolic acidosis associated with sodium thiosulfate therapy in a patient with calcific uremic arteriolopathy[J].Seminars in Dialysis,2011,24(1):85-88.
[4]聂凌,杨惠标.尿毒症心脏病变的研究进展[J].国外医学(泌尿系统分册),2004,24(3):408-412.
[5]盛斌,蔡启德,尹良红.尿毒症心脏损害的机制与研究进展[J].中国病理生理杂志,2003,19(5):712-716.
[6]卢光娅,谭若芸.不同血流量血液灌流联合血液透析治疗尿毒症的临床疗效观察[J].临床和实验医学杂志,2016,15(1):6-8.
[7]ANDERSEN P T,NIELSEN L K,CHRISTENSEN K S.Transcutaneous oxygen tension during hemodialysis in uremic patients with reduced cutaneous blood perfusion[J].Surgery,1988,104(3):584-587.
[8]REGOLISTI G,MAGGIORE U,CADEMARTIRI C A,et al.Cerebral perfusion during intermittent hemodialysis in patients with acute kidney injury and advanced liver cirrhosis[J].Journal of Nephrology,2013,26(4):771-777.
[9]韦秀芳,阮素莲,谢兴文.慢性肾功能衰竭行维持血液透析患者死亡原因及其影响因素分析[J].实用临床医药杂志,2016,20(3):160-161.
[10]成栋,周华虹,郎旭军,等.慢性肾衰竭血液透析患者泌尿系感染相关因素分析[J].中华医院感染学杂志,2017,27(5):1007-1010.
[11]杨亮.老年尿毒症病人血液透析诱导期心血管并发症的预防与护理[J].国际心血管病杂志,2017,44(A01):257-258.
[12]李有跃,谭光林,郭峰.生脉胶囊治疗尿毒症慢性心力衰竭疗效观察[J].西部医学,2015,27(9):1349-1351.
[13]杨成林,郑忠爱,肖斌,等.血液透析对难治性心力衰竭合并尿毒症患者血液生化指标和心功能的影响[J].医学综述,2016,22(7):1412-1414.
[14]张颖莹,张昆,王爱丽,等.RAAS对血液透析患者透析过程中血压波动的影响及相关因素分析[J].中国血液净化,2016,15(10):545-549.
[15]陆建洪,翁少翔,张树鑫,等.心力衰竭患者肺部感染血清细胞因子水平与心肌酶谱的变化研究[J].中华医院感染学杂志,2015,25(24):5618-5619,5636.