CVVHDF与CVVH改善尿毒症合并急性心力衰竭患者肌钙蛋白对照研究.docVIP

CVVHDF与CVVH改善尿毒症合并急性心力衰竭患者肌钙蛋白对照研究 　　[摘要] 目的 通过对心肌酶谱变化的监测，同时通过对治疗前后患者APACHE Ⅱ评分进行比较，研究CVVHDF和CVVH治疗对改善尿毒症合并急性心力衰竭患者心肌损伤的疗效分析。 方法 将尿毒症合并急性心衰患者分为两组，一组进行CVVH治疗，另一组进行CVVHDF治疗，通过监测患者肌钙蛋白的变化，评估患者心肌损伤的恢复状况，并在治疗前后进行APACHE Ⅱ评分。 结果 CVVH组和CVVHDF组治疗后都能很好的稳定患者生命体征，但CVVHDF组较CVVH组能更好的降低肌钙蛋白T以及肌钙蛋白Ⅰ指标，且CVVHDF组能更显著降低患者APACHE Ⅱ评分，显著改善患者预后。 结论 CVVHDF可以更好的保护受损心肌，改善患者心力衰竭状况。 　　[关键词] 尿毒症；心衰；连续性静静脉血液滤过；连续性静静脉血液滤过透析；心肌酶谱 　　[中图分类号] R541.6 [文献标识码] A [文章编号] 2095-0616（2017）15-233-04 　　[Abstract] Objective Through monitoring the changes of myocardial zymogram， and through comparing the score of the APACHE Ⅱ scores of patients before and after treatment，to investigate the efficacy of CVVHDF and CVVH in the treatment of myocardial injury in patients with uremia complicated with acute heart failure. Methods The patients with uremia complicated with acute heart failure were divided into two groups，one group received CVVH treatment，and the other group received CVVHDF treatment.The recovery of myocardial injury was assessed by monitoring changes in troponin levels and APACHE Ⅱ scores were measured before and after treatment. Results Both the CVVH and CVVHDF groups were able to stabilize the patients vital signs after treatment，but the CVVHDF group can better reduce the troponin T and troponin Ⅰ index than the CVVH group，and the CVVHDF group could significantly reduce the APACHE and Ⅱ scores and significantly improve the prognosis of the patients. Conclusion CVVHDF can better protect damaged myocardium and improve heart failure. 　　[Key words] Uremia；Heart failure；Continuous veno venous hemofiltration；Continuous veno venous hemofiltration dialysis；Myocardial enzymes 　　尿毒症主要是指人体不能正常通过肾脏排尿，从而无法将体内代谢产妇顺利排除体外所致的毒害，相对而言并不是一个独立的疾病，而是多种肾脏疾病综合作用的结果，属于慢性肾衰竭疾病发展至终末期诱发的一系列综合症[1-2]。调查显示，我国慢性肾脏疾病的发生率为10.8%，其中继发尿毒症的机率高达50.0%以上，由于病情不可逆，多数患者常在容量负荷过度、严重高血压、感染等情况下出现心力衰竭，严重威胁患者的生命安全[3]。目前持续肾脏替代治疗（CRRT）是治疗尿毒症的重要措施，包括连续性动静脉血液滤过（CAVH）、动静脉缓慢连续性超滤（SCUF）等多种模式，当患者合并心力衰竭时，CVVH和CVVHDF为目前临床最为常用的血液净化模式[4]。APACHE Ⅱ评分是一个判断患者预后