摘要
目的探讨重组人脑利尿钠肽(rhBNP)联合艾考糊精透析液序贯治疗腹膜透析(PD)合并慢性心力衰竭急性发作(ACHF)的疗效。方法PD合并ACHF患者45例,随机分为观察组(18例)和对照组(27例)。两组均给予rhBNP治疗72 h;对照组同时采用2.5%葡萄糖透析液,观察组在停止rhBNP后序贯7.5%艾考糊精透析液。治疗7 d后比较两组临床疗效、心脏结构和功能、透析充分性指标变化,观察患者近期预后,记录两组患者不良反应发生情况。结果观察组临床总有效率高于对照组(94.44%vs.66.67%),再次住院率低于对照组(5.56%vs.29.63%)(P<0.05)。治疗后,两组左心室射血分数(LVEF)、心脏指数较治疗前升高,且观察组高于对照组(P<0.05)。治疗后,两组左心室舒张末期内径(LVEDd)、SCr和BUN较治疗前降低,且观察组低于对照组(P<0.05)。观察组LVEF提升≥10%、LVEF提升≥50%、LVEDd缩小≥5 mm和LVEDd缩小≥10 mm的患者比例均高于对照组(P<0.05)。治疗后,两组尿素清除指数(Kt/V)、残肾Kt/V、内生肌酐清除率(Ccr)和残肾Ccr较治疗前升高,且观察组高于对照组(P<0.05)。两组不良反应发生率相仿(P>0.05)。结论rhBNP联合艾考糊精透析液序贯治疗PD合并ACHF临床疗效显著,可改善心脏结构和功能,提高透析充分性,降低再次住院率,且安全性高。
Objective To investigate the efficacy of recombinant human brain natriuretic peptide(rhBNP)combined with icodextrin dialysate in sequential treatment of peritoneal dialysis(PD)complicated with acute attack of chronic heart failure(ACHF).Methods A total of 45PD patients complicated with ACHF were randomly divided into two groups.The patients of both groups were treated with rhBNP for 72hours.Group A(27cases)received 2.5%glucose dialysate at the same time and group B(18cases)was given 7.5%icodextrin dialysate after stopping rhBNP.The clinical efficacy,cardiac structure and function,and dialysis adequacy indexes were compared between the two groups 7days after treatment.The short-term prognosis of the patients was observed.The occurrence of adverse reactions was recorded.Results The total effective rate was higher in group B than that in group A(94.44%vs.66.67%),while re-hospitalization rate was lower in group B than that in group A(5.56%vs.29.63%)(P<0.05).The left ventricular ejection fraction(LVEF)and cardiac index were higher after treatment than those before in two groups,which were higher in group B than those in group A after treatment(P<0.05).The left ventricular end-diastolic diameter(LVEDd),SCr and BUN of the two groups were lower after treatment than those before,which were lower in group B than those in group A after treatment(P<0.05).The proportions of the patients with LVEF increase≥10%,LVEF increase≥50%,LVEDd decrease≥5mm and LVEDd decrease≥10mm were higher in group B than those in group A(P<0.05).The Kt/V,residual kidney Kt/V,Ccr and residual kidney Ccr of the two groups were higher after treatment than those before,which were higher in group B than those in group A after treatment(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion rhBNP combined with icodextrin dialysate in sequential treatment of PD patients complicated with ACHF has remarkable clinical efficacy,which can improve cardiac structure and function,elevate d
作者
韩美香
黄益麒
沈伟钢
HAN Meixiang;HUANG Yiqi;SHEN Weigang(Department of Nephrology,Shaoxing Second Hospital,Shaoxing 312000,CHINA)
出处
《江苏医药》
CAS
2023年第10期997-1001,共5页
Jiangsu Medical Journal
基金
浙江省医药卫生科技计划(2023XY059)。
关键词
重组人脑利尿钠肽
艾考糊精透析液
腹膜透析
慢性心力衰竭
Recombinant human brain natriuretic peptide
Icodextrin dialysate
Peritoneal dialysis
Chronic heart failure
