摘要
目的评价超滤治疗心力衰竭(简称心衰)合并利尿剂抵抗的安全性及有效性。方法选取2019年1月至2020年2月于新乡医学院第一附属医院住院的有症状的心衰合并利尿剂抵抗患者84例,采用随机数字表法分为超滤治疗组及利尿剂治疗组,每组42例。利尿剂治疗组采用加大利尿剂用量、联合多巴胺或多种不同作用机制的利尿剂清除体液潴留。超滤治疗组采用超滤治疗,超滤治疗过程当中停用利尿剂。比较两组患者治疗后的电解质水平、血肌酐水平、血红蛋白水平、血小板计数、红细胞计数、血细胞比容及血尿素氮水平。治疗有效性的主要终点为治疗期间的负出水量(负出水量=总出水量-总入水量),次要终点包括随访3个月及1年内的心血管原因死亡、第一次心衰恶化再入院。结果出院前超滤治疗组负出水量为6024(3768,9966)ml,高于利尿剂治疗组的2633(920,7908)ml,差异有显著性(P<0.001)。出院前超滤治疗组N末端B型利钠肽原为8450(3406,21300)ng/L,低于利尿剂治疗组的11000(5060,35000)ng/L,差异有显著性(P<0.001)。随访3个月时,超滤治疗组第一次心衰再住院率(16.67%)低于利尿剂治疗组(35.71%),差异有显著性(P=0.047)。随访1年时两组心血管死亡率及心衰再入院率差异无显著性(P>0.05)。出院前超滤治疗组红细胞计数、血细胞比容及血尿素氮水平高于利尿剂治疗组(P<0.05),其余电解质水平、血红蛋白水平、血小板计数、血肌酐水平两组比较差异无显著性(P>0.05)。结论对于伴有体液潴留的心衰合并利尿剂抵抗患者,超滤治疗是有效清除体液潴留的方法,且具有较好的安全性。
Objective To evaluate the safety and efficacy of ultrafiltration in the treatment of heart failure(HF)with diuretic resistance.Method A total of 84 patients with symptomatic HF complicated with diuretic resistance who were hospitalized in the First Affiliated Hospital of Xinxiang Medical College from January 2019 to February 2020 were randomly divided into ultrafiltration treatment group and diuretic treatment group by using of random number table method with 42 patients in each group.Electrolyte,serum creatinine level,hemoglobin level,platelet count,red blood cell count,hematocrit and blood urea nitrogen level were compared between 2 groups after treatment.The primary endpoint was negative fluid equilibrium during hospitalization,and the secondary endpoints included cardiovascular death at 3 months and 1 year of follow-up,and first readmission for worsening HF.Result Before discharge,the negative fluid equilibrium of the ultrafiltration group was 6024(3768,9966)ml,which was significantly higher than that of the diuretic group of 2633(920,7908)ml(P<0.001).Before discharge,the N-terminal pro-B type natriuretic peptide in the ultrafiltration group was 8450(3406,21300)ng/L,which was significantty lower than that in the diuretic group of 11000(5060,35000)ng/L(P<0.001).At 3 months follow-up,the rate of first HF rehospitalization in the ultrafiltration group(16.67%)was significantly lower than that in the diuretic group(35.71%)(P=0.047).There were no significant differences in cardiovascular mortality and HF readmission rate between the two groups at 1 year follow-up(P>0.05).Before discharge,the levels of erythrocyte count,hematocrit and blood urea nitrogen in ultrafiltration group were higher than those in diuretic group(P<0.05),while there were no significant differences in other electrolyte levels,hemoglobin levels,platelet count and blood creatinine levels between the two groups(all P>0.05).Conclusion Ultrafiltration is an effective and safe method for removing fluid retention in diuretic resistant patients with HF
作者
侯云涛
周琼
袁宇
Hou Yuntao;Zhou Qiong;Yuan Yu(Coronary Artery Disease Intensive Care Unit,First Affiliated Hospital of Xinxiang Medical University,Henan Weihui 453100,China;Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,China)
出处
《中国医刊》
CAS
2022年第7期731-734,共4页
Chinese Journal of Medicine
基金
国家重点研发计划项目(2017YFC1308301,2017YFC1308305)。
关键词
超滤
利尿剂抵抗
体液潴留
心力衰竭
Ultrafiltration
Diuretic Resistance
Fluid retention
Heart Failure
