連續(xù)性血液凈化與間歇性血液透析治療終末期腎病合并急性冠脈綜合征的效果比較

廖安全　楊建泉　徐爍　黃貴陽

【摘要】 目的：比較連續(xù)性血液凈化與間歇性血液透析治療終末期腎病合并急性冠脈綜合征的臨床效果。方法：針對2017年6月-2019年2月本院收治的60例終末期腎病合并急性冠脈綜合征患者進(jìn)行治療觀察，隨機(jī)分成兩組。常規(guī)組30例患者實(shí)施間歇性血液透析治療，治療組30例患者實(shí)施連續(xù)性血液凈化治療，對比兩組治療效果。結(jié)果：兩組治療優(yōu)良率、并發(fā)癥發(fā)生率、血清BUN水平、血清Scr水平、LVEF指標(biāo)及SpO2、心率、血清肌鈣蛋白I水平等比較，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論：針對終末期腎病合并急性冠脈綜合征患者實(shí)施連續(xù)性血液凈化治療的效果優(yōu)于間歇性血液透析治療，改善患者各項(xiàng)指標(biāo)，減少并發(fā)癥的出現(xiàn)，對提高終末期腎病危重癥患者的搶救成功率有重要意義，但治療費(fèi)用較為昂貴，待患者冠心病病情穩(wěn)定后可采用間歇性血液透析維持性治療，此時(shí)仍無法耐受間歇性血液透析治療的患者如腹膜條件允許也可改為腹膜透析治療。

【關(guān)鍵詞】 連續(xù)性血液凈化; 間歇性血液透析; 終末期腎病; 急性冠脈綜合征

Clinical Efficacy Comparison of Continuous Blood Purification and Intermittent Hemodialysis in the Treatment of End-stage Renal Disease Complicated with Acute Coronary Syndrome/LIAO Anquan，YANG Jianquan，XU Shuo，et al.//Medical Innovation of China，2019，16（20）：-145

【Abstract】 Objective：To compare the clinical efficacy of continuous blood purification and intermittent hemodialysis in the treatment of end-stage renal disease complicated with acute coronary syndrome.Method：From June 2017 to February 2019，60 patients of end-stage nephropathy complicated with acute coronary syndrome were randomly divided into two groups.30 patients in routine group were given intermittent hemodialysis treatment，while the other 30 patients in treatment group were given continuous blood purification treatment.The therapeutic effects of two groups were compared.Result：After treatment，there were statistically significant differences in the efficacy of treatment，the incidence of complications，the level of BUN，Scr，LVEF，SpO2，heart rate and serum troponin I

between two groups（P<0.05）.Conclusion：The effect of continuous blood purification therapy for patients with end-stage renal disease complicated with acute coronary syndrome is better than that of intermittent hemodialysis.Improving the indexes of patients and reducing the occurrence of complications are of great significance to improve the success rate of rescue for critically severe patients with end-stage renal disease，but the cost of treatment is more expensive.Intermittent therapy can be used when the patients condition of coronary heart disease is stable，the maintenance therapy of hemodialysis can be replaced by peritoneal dialysis if the peritoneal condition permits.

【Key words】 Continuous blood purification; Intermittent hemodialysis; End-stage renal disease; Acute coronary syndrome

First-authors address：Heyuan Peoples Hospital，Heyuan 517000，China

doi：10.3969/j.issn.1674-4985.2019.20.037

慢性腎臟病（CKD）患者容易出現(xiàn)急性冠脈綜合征（ACS），近期，美國國家心血管資料注冊系統(tǒng)—急性冠脈綜合征治療和干預(yù)結(jié)果網(wǎng)絡(luò)（NCDR-ACTION）的數(shù)據(jù)顯示，近半數(shù)ACS患者常合并CKD，終末期腎病（ESRD）患者出現(xiàn)ACS會(huì)惡化預(yù)后，增加死亡率及出血風(fēng)險(xiǎn)。ACS是一組臨床綜合征，包括急性ST段抬高性心肌梗死、急性非ST段抬高性心肌梗死和不穩(wěn)定型心絞痛（UA），ACS患者常常表現(xiàn)為發(fā)作性胸痛、胸悶等癥狀，可導(dǎo)致心律失常、心力衰竭、甚至猝死，嚴(yán)重影響患者的生活質(zhì)量和壽命[1-2]。如及時(shí)采取恰當(dāng)?shù)闹委煼绞剑瑒t可大大降低病死率，并減少并發(fā)癥，改善患者的預(yù)后[3]，然而普通血液透析對機(jī)體血流動(dòng)力學(xué)影響較大，治療過程中容易誘發(fā)心絞痛、心律失常、低血壓等并發(fā)癥[4]，故ESRD合并ACS患者選擇科學(xué)有效的血液凈化方式顯得尤為重要。針對2017年