中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (05): 313-317.doi: 10.3969/j.issn.1671-4091.2017.05.008

• 临床研究 • 上一篇    下一篇

不同剂量左旋肉毒碱治疗维持性血液透析合并心力衰竭疗效观察

覃莲香1,张雪潇1,于春洋1,王艺萍1,肖跃飞1   

  1. 1. 航天中心医院肾内科(北京大学航天临床医学院)肾内科
  • 收稿日期:2016-05-30 修回日期:2017-03-17 出版日期:2017-05-12 发布日期:2017-05-19
  • 通讯作者: 王艺萍 wypdoc@sohu.com E-mail:wypdoc@sohu.com

Clinical observation of different L-carnitine doses for the treatment of heart failure in maintenance hemodialysis patients

  • Received:2016-05-30 Revised:2017-03-17 Online:2017-05-12 Published:2017-05-19

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摘要： 目的观察不同剂量左旋肉毒碱对慢性肾衰竭维持性血液透析合并心功能衰竭患者的影响。方法选择慢性肾衰竭维持性血液透析合并心力衰竭患者44 例，所有患者因心力衰竭行床边连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)并同时予以左旋肉毒碱静推，根据左旋肉毒碱剂量不同，随机分为2 组，A 组(大剂量治疗组)：每天给予左旋肉毒碱2g 加入O.9%的氯化钠注射液20 ml 静脉注射，连续应用14 天；B 组(常规剂量治疗组)：在CRRT 结束时予左旋肉毒碱1g 加入O.9%的氯化钠注射液20 ml 静脉注射，观察14 天。检测2 组治疗前后B 型尿钠肽(brain natriuretic peptide，BNP)以及心脏结构和功能的指标变化。结果A 组治疗后自身对比：左心室舒张末期内径(t=6.382、P＜0.001)、收缩末期内径明显缩小(t=3.174，P=0.003)，左室射血分数明显提高(t=2.978，P=0.007)，BNP 明显下降(t=-3.489，P=0.001)，有显著统计学差异。B 组治疗后自身对比:血BNP 明显下降(t=6.125,P＜0.001)；心脏射血分数升高(t=-2.324,P=0.037)，有统计学差异，而左室舒张末期容积(t=1.799, P=0.062)、左室收缩末期容积(t=1.401, P=0.115)较治疗前有下降趋势，但无统计学差异。治疗后A 组较B 组受试者BNP(t= 2.699, P=0.023)、左室舒张末期容积(t=2.332, P=0.031)、左室收缩末期容积显著减小(t=2.713, P=0.012)，左室射血分数升高更显著(t=2.224, P=0.042)，存在统计学差异。且A组最终回归门诊普通血液透析治疗比例较B 组多，有统计学差异(c2=4.041，P=0.044)。结论大剂量左旋肉毒碱联合CRRT 治疗可在较短时间内改善维持性血液透析合并心力衰竭患者的心脏功能、改善其左室重构，进而减少临床不良事件，改善患者预后。

关键词: 左旋肉毒碱, 维持性血液透析, 慢性心力衰竭, 心脏结构和功能

Abstract: Objective To observe different L-carnitine doses for patients on maintenance hemodialysis (MHD) complicated with heart failure. Methods This prospective study enrolled 44 patients on MHD for chronic renal failure and complicated with heart failure. They were treated with continuous renal replacement therapy (CRRT) at bedside and intravenous injection of L-carnitine for hear failure. They were randomly divided into 2 groups based on L-carnitine dose. Patients in groupA were treated with higher L-carnitine dose (2g L-carnitine in 20 ml 0.9% NaCl intravenously per day for 14 days); those in group B were treated with routine L-carnitine dose at the end of CRRT (1g L-carnitine in 0.9% NaCl intravenously per day for 14 days). Brain natriuretic peptide (BNP) and cardiac structure and function by echocardiography were examined before and after the treatment. Results In group A after the treatment, left ventricular end-diastolic diameter (t= 6.382, P＜0.001) and end-systolic diameter (t=3.174, P=0.003) decresed, left ventricular ejection fraction (t= 2.978, P=0.007) increased, and BNP decreased (t=- 3.489, P=0.001). In group B after the treatment, blood BNP decreased (t=6.125, P＜0.001), left ventricular ejection fraction increased (t=-2.324, P=0.037); left ventricular end-systolic volume (t=1.401, P=0.115) and left ventricular end-diastolic volume (t=1.799, P=0.062) decreased but without statisitcal significance. When comparison was made between group A and group B, BNP (t=2.699, P=0.023), left ventricular end- diastolic volume (t=2.332, P=0.031), and left ventricular endsystolic volume (t=2.713, P=0.012) decreased more in group A than in group B, while left ventricular ejection fraction (t=2.224, P=0.042) increased more in groupA than in group B. Eventually, the patients back to the routine hemodialysis department were more in group A than in group B (χ2=4.041, P=0.044). Conclusion Higher L-carnitine dose combined with CRRT were effective in a shorter period time to promote heart fuctions and left ventricular remodeling, to reduce clinical adverse events, and to improve prognosis in MHD patients with heart failure.

Key words: L-carnitine, Maintenance hemodialysis, Chronic heart failure, Cardiac structure and function