【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 m~2）以上，30例]、B组肌酐清除率[30～59 ml/（min·1.73 m~2）,34例]和C组[肌酐清除率15～29 ml/（min·1.73 m~2）,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 m~2）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 m~2）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。更多还原

【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·1.73m~2), n=30], group B [CCr=30～59 ml/(min·1.73 m~2), n=34] and group C [CCr=15～29 ml/(min·1.73 m~2), 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 24h, 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=30ml/(min·1.73 m~2) 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·1.73m~2) after ultrafiltration treatment for 24 h, but kidney function is improved significantly after 1 week.更多还原