连续性血液净化与间歇性血液透析治疗终末期肾病合并急性冠脉综合征的效果比较

廖安全　杨建泉　徐烁　黄贵阳

【摘要】 目的：比较连续性血液净化与间歇性血液透析治疗终末期肾病合并急性冠脉综合征的临床效果。方法：针对2017年6月-2019年2月本院收治的60例終末期肾病合并急性冠脉综合征患者进行治疗观察，随机分成两组。常规组30例患者实施间歇性血液透析治疗，治疗组30例患者实施连续性血液净化治疗，对比两组治疗效果。结果：两组治疗优良率、并发症发生率、血清BUN水平、血清Scr水平、LVEF指标及SpO2、心率、血清肌钙蛋白I水平等比较，差异均有统计学意义（P<0.05）。结论：针对终末期肾病合并急性冠脉综合征患者实施连续性血液净化治疗的效果优于间歇性血液透析治疗，改善患者各项指标，减少并发症的出现，对提高终末期肾病危重症患者的抢救成功率有重要意义，但治疗费用较为昂贵，待患者冠心病病情稳定后可采用间歇性血液透析维持性治疗，此时仍无法耐受间歇性血液透析治疗的患者如腹膜条件允许也可改为腹膜透析治疗。

【关键词】 连续性血液净化; 间歇性血液透析; 终末期肾病; 急性冠脉综合征

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

慢性肾脏病（CKD）患者容易出现急性冠脉综合征（ACS），近期，美国国家心血管资料注册系统—急性冠脉综合征治疗和干预结果网络（NCDR-ACTION）的数据显示，近半数ACS患者常合并CKD，终末期肾病（ESRD）患者出现ACS会恶化预后，增加死亡率及出血风险。ACS是一组临床综合征，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稳定型心绞痛（UA），ACS患者常常表现为发作性胸痛、胸闷等症状，可导致心律失常、心力衰竭、甚至猝死，严重影响患者的生活质量和寿命[1-2]。如及时采取恰当的治疗方式，则可大大降低病死率，并减少并发症，改善患者的预后[3]，然而普通血液透析对机体血流动力学影响较大，治疗过程中容易诱发心绞痛、心律失常、低血压等并发症[4]，故ESRD合并ACS患者选择科学有效的血液净化方式显得尤为重要。针对2017年