标题：床旁血滤联合BiPAP无创机械通气治疗难治性终末期心衰效果观察

      作者：王 霞，陈晋波，梁小华
    (石家庄市第二医院心内科三病区，河北 石家庄 050051)

      卷次： 2015年26卷2期

      【摘要】 目的 探讨床旁血液滤过(CRRT)联合BiPAP无创机械通气治疗顽固性心力衰竭的临床治疗效
果。方法 根据治疗方法不同将我院300例顽固性心力衰竭患者分为两组，均给予标准药物治疗，对照组143例加
用BiPAP无创机械通气治疗、研究组157例应用连续性CRRT联合BiPAP无创机械通气治疗，观察治疗前后两组患
者的生命体征、NT-pro-BNP、左室射血分数、血肌酐、动脉氧分压等指标的变化和治疗效果。结果 对照组治疗前后
NT-pro-BNP值分别为(1 996±63.7) pg/ml和(875±29.4) pg/ml，研究组分别为(2 096±62.8) pg/ml、(565±30.0) pg/ml；
两组患者治疗后NT-pro-BNP值均明显降低，与治疗前比较差异均有统计学意义(P<0.01)，研究组疗效更佳；对
照组治疗前后血氧分压分别为(69.96±6.37) mmHg和(87.5±2.94) mmHg，研究组分别为(68.86±6.28) mmHg和
(92.5±3.00) mmHg；两组患者治疗后血氧分压值均明显升高，与治疗前比较差异均有统计学意义(P<0.01)；研究组
患者治疗后血氧分压值明显低于对照组，且两组间比较差异有统计学意义(P<0.01)；对照组治疗前后肌酐值分别
为(199.6±63.7) ?mol/L和(87.5±2.94) ?mol/L，研究组分别为(198.6±62.8) ?mol/L和(76.5±3.00) ?mol/L，两组患者
治疗后血肌酐值均明显降低，与治疗前比较差异均有统计学意义(P<0.01)；研究组患者治疗后血肌酐值明显低于
对照组，且两组间比较差异有统计学意义(P<0.05)；研究组患者治疗后胸片渗出水肿改变及心脏彩超改变有效率
为84.7%，对照组为71.3%，两组间比较差异有统计学意义(P<0.05)；研究组患者治疗后呼吸困难症状及心功能分
级及活动能力有效率为 82.8%，对照组为 69.9%，两组间比较差异有统计学意义(P<0.05)；研究组患者生存率为
86.0%，对照组为76.9%，两组患者生存率比较差异有统计学意义(P<0.05)。结论 床旁血液滤过联合BiPAP无创
机械通气治疗能有效缓解顽固性心力衰竭的临床症状，改善心功能，提高了抢救成功率，是一种积极、安全、有效
地新型治疗方法。

      【关键词】 床旁血液滤过；双水平气道正压通气；难治性终末期心衰；NT-pro-BNP；心功能；血肌酐；动脉氧分压

      【中图分类号】 R541.6 【文献标识码】 A 【文章编号】 1003—6350（2015）02—0169—03


Clinical effect of continuous renal replacement therapy (CRRT) combined with BiPAP noninvasive ventilation
in the treatment of refractory end-stage heart failure.
WANG Xia, CHEN Jin-bo, LIANG Xiao-hua. The Third Ward
of Department of Cardiology, the Second Hospital of Shijiazhuang, Shijiazhuang 050051, Hebei, CHINA

【Abstract】 Objective To explore the clinical effect of continuous renal replacement therapy (CRRT) com-
bined with BiPAP noninvasive ventilation on refractory end-stage heart failure. Methods Three hundred patients cas-
es with refractory end-stage heart failure were divided into two groups according to different treatment in our hospital.
All of them were given standard drug. In control group, 143 patients were given BiPAP, while in research group, 157
patients were given CRRT combined with BiPAP. The vital signs, NT-pro-BNP, LVEF, CRE, PaO2 and effect were ob-
served and compared before and after treatment in the two groups. Results Compared to before treatment, the values
of NT-pro-BNP after treatment significantly decreased in both control group and research group [(1 996±63.7) pg/ml
vs (875±29.4) pg/ml, (2 096±62.8) pg/ml vs (565±30.0) pg/ml, respectively, P<0.01]. The effect was better in research
group. After treatment, the PaO2 in both groups were statistically significantlyincreased than those before treatment
[(87.5±2.94) mmHg vs (69.96±6.37) mmHg, (92.5±3.00) mmHg vs (68.86±6.28) mmHg, respectively, P<0.01].
After treatment, the CRE in both groups were statistically significantly decreased than those before treatment
[(199.6±63.7) ?mol/L vs (87.5±2.94) ?mol/L, (198.6±62.8) ?mol/L vs (76.5±3.00) ?mol/L, respectively, P<0.01).
There was a statistically significant difference between the two groups (P<0.05). The effective rate of the change on drop-
sy and exudation on rabat and heart doppler ultrasound, the effective rate on the dyspnea, heart function classification and