【摘要】目的探讨老年重度心力衰竭患者合并急性肾功能损伤(acute renal function injury, AKI)时，连续性肾脏替代疗法(continuous renal replacement therapy，CRRT)的介入时机与疗效的相关性。方法选取2017 年8 月～2019 年6 月在汕头市潮阳区大峰医院接受治疗的老年重度心力衰竭合并AKI 患者的临床资料进行分析，按照CRRT 的介入时机分为2 组。其中入院后6h 内行CRRT 为早期组(实验组),6～12h 内行CRRT 为晚期组(对照组)。记录患者机械通气时间、CRRT 治疗时间、ICU 住院时间、患者病死率(14d、28d)。同时监测患者行CRRT 治疗前后生命体征、血钾、血钠水平。结果2 组患者机械通气时间无差别(t=0.071，P=0.472)，实验组患者CRRT 治疗时间、ICU 住院时间均较对照组短(t=4.700，3.596，P＜0.001)；2 组患者14 天病死率无差别(χ2=0.351，P=0.554)，实验组28 天病死率低于对照组(χ2=4.043，P=0.044)；治疗后，实验组心率、右上肢血压收缩压、右上肢血压舒张压高于对照组(t= 6.276、30.561、10.887，P＜0.001)，呼吸次数低于对照组(t=4.224，P＜0.001)；治疗后，实验组的钾、钠水平低于对照组(t= 3.325、10.646，P＜0.001)。结论CRRT 对老年重度心力衰竭患者合并AKI 患者有较好的治疗效果，可缩短患者的住院时间，改善患者的预后，具有良好的临床应用价值。
【Abstract】Objective To explore the correlation between timing of continuous renal replacement therapy (CRRT) and efficacy in elderly patients with severe heart failure complicated with acute renal function injury (AKI). Methods Elderly severe heart failure patients with AKI treated in our hospital from August 2017 to June 2019 were enrolled. Patients were divided into 2 groups according to the timing of CRRT: experimental group (start CRRT Within 6 hours after admission) and control group (start CRRT at 6～12 hours after admission). The mechanical ventilation time, CRRT treatment time, ICU stay length, and mortality (within 14 days and 28 days) of patients were recorded. Meanwhile, patients were monitored for changes in vital signs, serum potassium and sodium level before and after CRRT. Results The treatment time and ICU stay length of patients in the experimental group were shorter than those in the control group (t=4.700 and 3.596,respectively, P=0.001). Meanwhile, the mortality within 28 days of patients in the experimental group was lower than that in the control group (χ2=4.043, P=0.044).However, no significant differences in mechanical ventilation time (t=0.071, P=0.472) and the mortality within 14 days (χ2=0.351,P=0.554) between the two groups. After CRRT, patients in the experimental group had higher heart rate, systolic blood pressure, diastolic blood pressure (t=6.276, 30.561, 10.887, P=0.001) and lower respiratory rate, serum potassium and sodium levels (t=4.224, 3.325, 10.646, P= 0.001) than those in the control group. Conclusion CRRT has good therapeutic effect on elderly patients with severe heart failure complicated with AKI. CRRT can shorten the hospitalization stay length and improve patient’s prognosis, which has good clinical application value.
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