The Application Of Early Continuous Renal Replacement Therapy In Patients With Heart Failure And Acute Renal Injury

Objective: To explore the value of early continuous renal replacement therapy in pati ents with heart failure and acute renal injury(AKI).Methods: In this study,80 patients with heart failure and acute kidney injury were selected from the intensive care unit(ICU)of our hospital.which was selected for the heart failure is to accord with the Chinese medical association branch of cardiovascular disease heart failure diagnosis standard and the New York heart association(NYHA)class for Ⅲ-Ⅳ heart adults;Acute renal injury was assessed by acute kidney injury in 2006.These patients received renal replacement therapy and informed consent of this study.Exclude complicating acute myocardial infarction,severe valvular disease,myocarditis,pericarditis and severe arrhythmia,acute brain stroke,autoimmune disease,patients with malignant tumor,chronic kidney disease(CKD)and end-stage renal disease patients eliminate combined with mental disease and cognitive impairment or death within 24 h of admission of the patient.Randomly divided into observation group(n=40)and control group(n=40).After entering the ICU,both groups of patients were routinely given oxygen,diuretic,nutritional myocardium,norepinephrine or dopamine and(or dobutamine)raise blood pressure,nitric acid and other drugs,and maintain water electrolyte balance,correct acidosis,when necessary to nutrition support,mechanical ventilation support.And were treated with continuous renal replacement therapy(CRRT),of which occurred within 48 h in the observation group,oliguria,but without the high potassium,serum creatinine(Scr)or less 200 umol/L that give continuous renal replacement therapy(CRRT),control group is 72 h or oliguria,appear hyperkalemia or Scr > 200 umol/L give continuous renal replacement therapy(CRRT)and compared before and after treatment the patient serum creatinine(Scr),brain natriuretic peptide(BNP),serum c-reactive protein(CRP)and APACHE Ⅱ ratings,compared two groups of patients before and after the treatment hemodynamic indexes,including mean arterial pressure(MAP),the change of heart rate(HR),recorded in the two groups live time of ICU mortality and 28 days.Avoid adverse reactions and risks during CRRT.Results:(1)After treatment,serum creatinine(Scr),brain natriuretic peptide(BNP),serum c-reactive protein(CRP)levels and APACHE Ⅱ score of the two groups were decreased significantly,and the observation group was lower than the control group,the serum creatinine(Scr)and serum c-reactive protein(CRP)were restored to normal in some patient,the difference was statistically significant(P < 0.05);(2)After treatment,the hemodynamic level of the two groups was significantly better than that before treatment,and some patients did not need vasoactive drugs to maintain blood pressure and heart rate.MAP significantly increased,HR decreased significantly in two groups,the difference was of statistically significant(P < 0.05);(3)ICU stay time in the observation group was shorter than the control group(P < 0.05);(4)The mortality rate were compared between the two groups,there was of statistically significant difference(P < 0.05);(5)During the treatment period,no severe adverse reaction appeared in two groups.Conclusion: Continuous renal replacement therapy(CRRT)reduces the cardiac load by removing excess water in the body,thereby improving the blood supply of myocardium metabolism.Early application of CBP for patients with heart failure complicated with AKI can effectively reduce serum inflammatory factors,improve cardiac function and renal function,promote disease recovery and shorten ICU stay time.