【摘要】 目的 探讨自动腹膜透析(APD)治疗心肾综合征(CRS)的临床效果。方法 40例CRS患者为研究对象,均采用APD治疗。比较患者治疗前后血清生化指标[血尿素氮、血肌酐、血清白蛋白、脑利钠肽(BNP)、C反应蛋白(CRP)以及血钾]、心功能指标[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)以及左心室收缩末期内径(LVESD)]、平均动脉压、体重以及临床症状评分。随访1年,记录死亡率、再住院率、并发症发生情况以及残余肾功能(RRF)。结果 患者治疗前、治疗3 d后、治疗7 d后的血尿素氮、血肌酐、血清白蛋白、BNP、CRP、血钾比较,差异有统计学意义(P<0.05)。治疗3、7 d后,患者血尿素氮、血肌酐、BNP、CRP、血钾均低于治疗前,血清白蛋白均高于治疗前,差异均有统计学意义(P<0.05)。治疗7 d后,患者LVEDD、LVESD与治疗前比较差异无统计学意义(P>0.05)；治疗7 d后,患者LVEF(45.85±4.20)%高于治疗前的(41.09±3.77)%,差异有统计学意义(P<0.05)。治疗7 d后,患者体重与治疗前比较差异无统计学意义(P>0.05)；治疗7 d后,患者平均动脉压(82.54±5.64)mm Hg(1 mm Hg=0.133 kPa)高于治疗前的(76.39±5.91)mm Hg,临床症状评分(9.06±3.37)分低于治疗前的(14.83±4.23)分,差异有统计学意义(P<0.05)。随访1年,患者的死亡率为5.0%(2/40),再住院率为45.0%(18/40),并发症发生率为37.5%(15/40)。存活的38例患者治疗后1年的残余肾尿素清除率(KRU)为(1.12±0.18)ml/min,低于治疗前的(1.52±0.23)ml/min,差异有统计学意义(P<0.05)。结论 APD治疗CRS的效果显著,有助于促进患者心功能恢复,改善患者血清生化指标水平,缓解临床症状。更多还原

【Abstract】 Objective To discuss the clinical effect of automatic peritoneal dialysis(APD) in the treatment of cardiorenal syndrome(CRS). Methods 40 CRS patients were selected as the research subjects,and all of them were treated with APD. Comparison was made on serum biochemical indexes [blood urea nitrogen, serum creatinine, serum albumin, brain natriuretic peptide(BNP), C-reactive protein(CRP), and serum potassium], cardiac function indexes [left ventricular ejection fraction(LVEF), left ventricular end-diastolic diameter(LVEDD) and left ventricular end-systolic diameter(LVESD)], mean arterial pressure, body weight,and clinical symptom scores before and after treatment. The mortality, rehospitalization rates, occurrence of complications, and residual renal function(RRF) were recorded at 1 year of follow-up. Results There were statistically significant differences in blood urea nitrogen, serum creatinine, serum albumin, BNP, CRP, and serum potassium before treatment, 3 d after treatment, and 7 d after treatment(P<0.05). At 3 and 7 d after treatment, the blood urea nitrogen, serum creatinine, BNP, CRP, and serum potassium were lower than those before treatment,and serum albumin was higher than that before treatment, and the differences were all statistically significant(P<0.05). At 7 d after treatment, there was no statistically significant difference in LVEDD and LVESD compared with those before treatment(P>0.05). At 7 d after treatment, the LVEF of patients was(45.85±4.20)%, which was higher than(41.09±3.77)% before treatment, and the difference was statistically significant(P<0.05). At 7 d after treatment, there was no statistically significant difference in body weight compared with that before treatment(P>0.05). At 7 d after treatment, the mean arterial pressure(82.54±5.64) mm Hg(1 mm Hg=0.133 kPa)of the patient was higher than(76.39±5.91) mm Hg before treatment, and the clinical symptom score(9.06±3.37) points was lower than(14.83±4.23) points before treatment, and the differences were all statistically significant(P<0.05). At 1-year follow-up, the mortality rate was 5.0%(2/40), the readmission rate was 45.0%(18/40), and the complication rate was 37.5%(15/40). The residual renal urea clearance(KRU) of the 38 patients who survived was(1.12±0.18) ml/min at 1 year after treatment, which was lower than(1.52±0.23) ml/min before treatment, and the difference was statistically significant(P<0.05). Conclusion APD is effective in the treatment of CRS, which helps to promote the recovery of cardiac function, improve the level of serum biochemical indicators and alleviate clinical symptoms.更多还原