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目的分析预测连续性血液净化在心肾综合征(CRS)治疗中的有效因素,以指导进行连续性血液净化(CRRT)的时机。方法回顾性分析本科2010年01月至2012年11月间采用CRRT治疗心肾综合征的33例患者临床资料。比较有效组及未愈组进行CRRT前后的尿量、液体平衡、血肌酐、急性生理和慢性健康评估Ⅱ(APACHEⅡ)、左心室射血分数(LVEF)、左心室(LV)、心输出量(CO)、B型尿钠肽(BNP)及中心静脉压(CVP)的变化。结果 CRRT治疗前有效组在APACHEⅡ评分、BNP及CVP比未愈组低,两组CRRT治疗前尿量、血肌酐、LVEF、LV及CO差异无统计学意义;CRRT治疗后有效组与未愈组APACHEⅡ评分、LVEF、BNP、CVP及CO比较差异有统计学意义,尿量、血肌酐及LV两组CRRT治疗后差异无统计学意义。有效组全部患者在治疗过程中均可达到负平衡,未愈组仅40%的患者可达负平衡。结论当CRS患者接受CRRT治疗前APACHEⅡ评分、BNP及CVP较低时,预后较好。CRRT治疗过程中,APACHEⅡ评分、LVEF、BNP、CVP及CO好转及液体负平衡的患者预后较好。
Objective To analyze the factors that predict the success of continuous blood purification in the treatment of cardiorenal syndrome (CRS) to guide the timing of continuous blood purification (CRRT). Methods The clinical data of 33 patients with cardio-renal syndrome treated with CRRT from January 2010 to November 2012 were retrospectively analyzed. The urine volume, fluid balance, serum creatinine, APACHEⅡ, LVEF, LV, CO), B-type natriuretic peptide (BNP) and central venous pressure (CVP). Results There was no significant difference in APACHEⅡscore, BNP and CVP between CRRT effective group and unhealed group before CRRT treatment. There was no significant difference in urinary output, serum creatinine, LVEF, LV and CO before CRRT treatment. APACHEⅡscore, LVEF, BNP, CVP and CO were significantly different. There was no significant difference in urine volume, serum creatinine and LV after treatment with CRRT. All patients in the effective group can achieve negative balance during the treatment, and only 40% of patients in the unhealed group can achieve negative balance. Conclusions The prognosis is better when the APACHE II score, lower BNP and CVP before CRR patients receive CRRT. During CRRT, patients with APACHEⅡscore, LVEF, BNP, CVP, and CO improvement and fluid negative balance had a better prognosis.