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急性心力衰竭患者接受超滤治疗对肾功能的影响

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摘要:

目的 观察超滤治疗急性心力衰竭(简称急性心衰)患者对不同水平肾功能的影响。方法 将
81例接受超滤治疗的急性心衰患者,按超滤前肌酐清除率分为A组[肌酐清除率60 ml/(min·1.73 m2)以
上,30例]、B组肌酐清除率[30~59 ml/(min·1.73 m2),34例]和C组[肌酐清除率15~29 ml/(min·1.73 m2),
17例]。观察超滤治疗后24 h、1周血肌酐、肌酐清除率水平、红细胞压积(HCT)及血尿素氮肌酐比值的变
化。结果 A组和B组患者在超滤治疗后24 h肌酐、肌酐清除率、HCT较超滤前有统计学差异(P<0.05),
肌酐水平较前升高,肌酐清除率水平较前下降,HCT较前升高,而超滤治疗后24 h血尿素氮肌酐比值较超
滤前比较无统计学差异(P>0.05);A组和B组患者在超滤治疗后1周肌酐、肌酐清除率、HCT及血尿素氮
肌酐比值较治疗前无统计学差异(P>0.05)。C组患者在超滤治疗后24 h肌酐、肌酐清除率、HCT、血尿
素氮肌酐比值较超滤前无统计学差异(P>0.05);在超滤治疗后1周肌酐和肌酐清除率较治疗前有统计学
差异(P<0.05),且肌酐水平较前下降,肌酐清除率较前升高,但HCT、血尿素氮肌酐比值较治疗前无统
计学差异(P>0.05)。结论 肌酐清除率在30 ml/(min·1.73 m2)以上的急性心衰患者行超滤治疗后24 h肾
功能有所下降,可能与血液浓缩相关,但1周后肾功能得到恢复。肌酐清除率15~29 ml/(min·1.73 m2)的
急性心衰患者行超滤治疗后24 h肾功能无变化,但1周后肾功能得到明显改善。

Abstract:

Objective To observe the influence of ultrafiltration treatment on patients with acute heart failure
(AHF) and different levels of kidney function. Methods AHF patients (n=81) undergone ultrafiltration treatment
were divided, according to pre-ultrafiltration creatinine clearance rate (CCr), into group A [CCr=60 ml/(min·1.73
m2), n=30], group B [CCr=30~59 ml/(min·1.73 m2), n=34] and group C [CCr=15~29 ml/(min·1.73 m2), n=17].
The level changes of serum creatinine (SCr), CCr, hematocrit value (HCT) and ratio of blood urea nitrogen (BUN)
to SCr (BUN/SCr) were observed after treatment for 24 h and 1 week. Results After ultrafiltration treatment for 24
h, SCr, CCr and HCT had statistical difference (P<0.05), and SCr level increased, CCr level decreased and HCT
increased, while BUN/SCr had no statistical difference (P>0.05) compared with before ultrafiltration treatment in
groups A and B. After ultrafiltration treatment for 1 week, SCr, CCr, HCT and BUN/SCr had no statistical difference
(P>0.05) compared with before ultrafiltration treatment in groups A and B. After ultrafiltration treatment for 24 h,
SCr, CCr, HCT and BUN/SCr had no statistical difference (P>0.05) compared with before ultrafiltration treatment
in group C. After ultrafiltration treatment for 1 week, SCr and CCr had statistical difference (P<0.05), and SCr level
decreased and CCr increases, but HCT and BUN/SCr had no statistical difference (P>0.05) compared with before
ultrafiltration treatment in group C. Conclusion The kidney function decreases in AHF patients with CCr=30
ml/(min·1.73 m2) after ultrafiltration treatment for 24 h, which may be related to hemoconcentration, and kidney
function recovers after 1 week. The kidney function has no changes in AHF patients with CCr=15~29 ml/(min·1.73
m2) after ultrafiltration treatment for 24 h, but kidney function is improved significantly after 1 week.

基金项目:

清华大学春风基金(2020Z99CFY037)

参考文献:

  • 2008

  • 1

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