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目的探讨连续性肾脏替代治疗(CRRT)在1型心肾综合征(CRS)患者中的治疗作用。方法回顾性分析了2011年10月到2015年10月中山大学附属第一医院心脏重症监护室因急性失代偿心力衰竭入院,后出现急性肾损害和(或)利尿剂抵抗,进行CRRT治疗的成人患者的资料。研究主要终点为住院期间的病死率,并进一步评估住院期间患者死亡的独立危险因素。结果 1型CRS患者行CRRT治疗的院内病死率为48%(12/25),出院患者需要规律透析的比例为45%(6/13)。CRRT治疗48 h后较治疗前心率(次/min)显著下降(87±15对100±17,P<0.001),NT-pro BNP(ng/L)也显著下降[26990(8710~50106)对34968(13914~55822),P=0.002];1型CRS患者进行CRRT治疗的住院期间死亡的独立危险因素为左室舒张末内径LVED(OR 1.282,95%CI 1.049~1.568,P=0.015)和CRRT治疗次数(OR 1.180,95%CI 1.011~1.377,P=0.036)。结论 1型CRS患者行CRRT治疗48 h后部分实验室和临床指标较治疗前好转,但患者住院期间仍然有着很高的病死率,尤其是那些CRRT治疗次数较多和LVED值较高的患者。因而CRRT对于1型CRS患者预后的改善仍不明确。
Objective To investigate the therapeutic effect of continuous renal replacement therapy (CRRT) in type 1 heart-kidney syndrome (CRS). Methods A retrospective analysis was conducted from October 2011 to October 2015 in the First Affiliated Hospital of Sun Yat-sen University Cardiology intensive care unit admitted to hospital after acute decompensated heart failure, after acute renal injury and / or diuretic resistance, CRRT treatment Information on adult patients. The primary end point of the study was mortality during hospitalization and further evaluation of independent risk factors for death during hospitalization. Results In-hospital mortality was 48% (12/25) for CRRT in type 1 patients and 45% (6/13) for regular dialysis in discharged patients. The CR rate of NT-pro BNP (ng / L) was also significantly decreased after treatment with CRRT for 48 h (87 +/- 15 vs 100 +/- 17, P <0.001) (OR 1.282, 95% CI 1.049-1.568, P = 0.015), and the independent risk factors for death during hospitalization for type 1 CRS patients with CRRT were 34968 (13914-5822), P = 0.002] The number of CRRT treatments (OR 1.180, 95% CI 1.011-1.377, P = 0.036). Conclusions Some patients with type 1 CRS treated with CRRT improved their laboratory and clinical parameters 48 h after treatment. However, patients with CRS still had a high mortality during hospitalization, especially those with high CRRT and LVED values. Therefore, the improvement of CRRT for the prognosis of patients with type 1 CRS remains unclear.