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目的评估连续肾脏替代治疗(CRRT)在肾功能衰竭(CRF)合并急性失代偿性充血性心力衰竭(ADHF)患者中挽救治疗的效果。方法回顾性收集2010年1月至2015年12月同济大学附属第十人民医院肾功能衰竭患者因急性心功能衰竭无法耐受普通血液透析治疗,而改用CRRT治疗的左室射血分数减少患者的临床资料。主要的研究终点为30 d内患者全因死亡率、180 d内患者全因再住院率及因心力衰竭加重导致再住院的比例,并进一步通过Logistic回归分析评估30 d内导致患者死亡的危险因素。结果研究共纳入了17例患者,在CRRT挽救治疗的患者中,30 d内全因死亡率及心血管事件死亡率为23.5%(4/17)、17.6%(3/17);在存活患者当中,180 d内全因再住院率为53.8%(7/13),因心力衰竭加重而导致的再住院率为23.1%(3/13);与存活患者相比,30 d内死亡患者收缩压更低(P=0.001)。结论肾衰合并ADHF患者CRRT挽救治疗后仍有较高的病死率,且存活患者再住院率明显偏高,治疗起始时低收缩压患者病死率更高。
Objectives To evaluate the effect of continuous renal replacement therapy (CRRT) on salvage therapy in patients with renal failure (CRF) and acute decompensated congestive heart failure (ADHF). Methods Retrospectively collected patients with renal failure due to acute heart failure who were unable to tolerate general hemodialysis in the Tenth People’s Hospital affiliated to Tongji University from January 2010 to December 2015 and who underwent CRRT with reduced left ventricular ejection fraction The clinical data. The primary end point of the study was all-cause mortality in patients within 30 days, rehospitalization rate in all patients within 180 days, and rehospitalization due to increased heart failure. Logistic regression analysis was further used to assess the risk factors for death within 30 days . Results A total of 17 patients were enrolled in this study. All-cause mortality and cardiovascular events within 30 days of CRRT were 23.5% (4/17) and 17.6% (3/17), respectively. Among survivors Among them, the rate of all-cause rehospitalization within 180 days was 53.8% (7/13), and the rate of rehospitalization due to worsening heart failure was 23.1% (3/13). Patients who died within 30 days contracted Pressure was lower (P = 0.001). Conclusions There is still a high mortality rate after CRRT salvage therapy in patients with renal failure and ADHF, and the rehospitalization rate of survivors is obviously higher. The mortality of patients with low systolic pressure is higher at the beginning of treatment.