摘要
目的评价超滤治疗对心力衰竭(心衰)合并利尿剂抵抗(DR)患者左心室射血分数(LVEF)、肺动脉收缩压(PASP)和下腔静脉塌陷指数(IVC-CI)百分数(%)及N末端B型利钠肽原(NT-proBNP)等反应血流动力学指标的影响。方法回顾性纳入2018年5月至2023年5月新疆维吾尔自治区中医医院心脏重症监护室(CCU)收治的心衰合并DR患者,按照1∶1倾向性评分匹配方法分为接受超滤治疗48~72h组(观察组)和强化利尿治疗72h组(对照组)。比较两组患者治疗前后LVEF、PASP、IVC-CI(%)及NT-proBNP等指标的变化情况。结果本研究纳入82例患者,观察组和对照组各41例。(1)超滤治疗72h后观察组患者的LVEF水平由(31.54±4.49)%升高至(38.51±4.98)%(P<0.001),对照组由(31.29±4.03)%升高至(32.32±3.77)%(P<0.001),治疗后观察组患者的LVEF水平高于对照组(P<0.001)。(2)超滤治疗72h后观察组患者的PASP水平由(48.51±6.03)mmHg下降至(32.90±5.87)mmHg(P<0.001),对照组由(47.02±5.73)mmHg下降至(41.90±5.77)mmHg(P<0.001),治疗后观察组患者的PASP水平低于对照组(P<0.001)。(3)超滤治疗72h后观察组患者的IVC-CI(%)由(24.97±8.40)%提高至(29.34±8.62)%(P<0.001),对照组由(24.88±5.81)%下降至(24.67±6.01)%(P=0.478),治疗后观察组患者的IVC-CI(%)水平高于对照组(P=0.006)。(4)超滤治疗72h后观察组患者的NT-proBNP水平由(4155.56±517.78)pg/mL下降至(1977.37±599.18)(P<0.001),对照组由(4111.51±482.97)pg/mL下降至(3423.78±518.27)pg/mL(P<0.001),治疗后观察组患者的NT-proBNP水平低于对照组(P<0.001)。(5)治疗后观察组患者的体质量降低,心率减慢,24h尿量增加,与对照组患者比较,差异均有统计学意义(P均<0.001)。结论心衰合并DR患者应用超滤治疗能够显著改善容量负荷,提高LVEF,降低PASP,提高IVC-IC,降低NT-proBNP水平。
ObjectiveTo evaluate the effect of ultrafiltration therapy on hemodynamic indexes including left ventricular ejection fraction(LVEF),pulmonary artery systolic pressure(PASP),percentage of inferior vena cava collapse index(IVC-IC)%and N terminal-B type natriuretic peptide(NT-proBNP)in patients with heart failure(HF)complicated with diuretic resistance(DR).MethodsPatients with HF and DR admitted to the Cardiac Intensive Care Unit(CCU)of Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine from May 2018 to May 2023 were retrospectively included and divided into ultrafiltration therapy for 48-72 hours group(observation group)and intensified diuretic treatment for 72 hours group(control group)by using of propensity score matching(PSM)method at a ratio of 1∶1.The changes of hemodynamic indexes such as LVEF,PASP,IVC-CI(%)and NT-proBNP before and after treatment were compared between the two groups.ResultsA total of 82 patients were included in this study,with 41 in the observation group and other 41 in the control group.After 72h of ultrafiltration treatment,(1)LVEF increased from(31.54±4.49)%to(38.51±4.98)%(P<0.001)in the observation group,and from(31.29±4.03)%to(32.32±3.77)%(P<0.001)in the control group,showing a higher LVEF level in the observation group than that in the control group(P<0.001)after treatment.(2)PASP decreased from(48.51±6.03)mmHg(1 mmHg=0.133 kPa)to(32.90±5.87)mmHg(P<0.001)in the observation group,and decreased from(47.02±5.73)mmHg to(41.90±5.77)mmHg(P<0.001)in the control group,showing a lower PASP in the observation group than that in the control group(P<0.001)after treatment.(3)IVC-CI(%)increased from(24.97±8.40)%to(29.34±8.62)%(P<0.001)in the observation group,and decreased from(24.88±5.81)%to(24.67±6.01)%in the control group(P=0.478),showing a higher IVC-CI(%)in the observation group than that in the control group(P=0.006)after treatment.(4)NT-proBNP decreased from(4155.56±517.78)pg/mL to(1977.37±599.18)(P<0.001)in the observation group,and decreased from(4111.51±482.97)pg/mL to(3423.78±518.27)pg/mL(P<0.001)in the control group,showing a lower NT-proBNP in the observation group than that in the control group(P<0.001)after treatment.(5)Compared to those in the control group,there were significantly lower body weight,heart rate and more 24h urine volume after treatment in the observation group(all P<0.001).ConclusionThe application of ultrafiltration therapy can significantly improve the volume overload in patients with HF and DR,showing an increase in LVEF,IVC-CI(%),decrease in PASP and NT-proBNP.
作者
秦可隽
沈祥礼
李岚
祖丽比亚·艾萨
张亚豪
姜述斌
Qin Kejuan;Shen XiangLi;Li Lan;Zulibiya·Aisa;Zhang YaHao;Jiang Shubin(The Fourth Clinical Medical College of Xinjiang Medical University,Urumqi 830000,China;Department of Cardiology,The Fourth Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China)
关键词
超滤
心力衰竭
利尿剂抵抗
肺动脉收缩压
下腔静脉塌陷指数
Ultrafiltration therapy
Heart failure
Diuretic resistance
Pulmonary artery pressure
Inferior vena cava collapsibility index
作者简介
通信作者:姜述斌,E-mail:13565852840@139.com。
