在左心室辅助装置植入后,循环利尿效率的连续评估
Sarah M Beargie1, Lindsey Tolbert2, Robert K Tunney2
1Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA.
The International journal of artificial organs
|August 30, 2023
概括
晚期心力衰竭患者的利尿反应在左心室辅助装置 (LVAD) 植入后没有得到改善. 大多数患者在手术后仍然需要尿剂,这表明需要进一步研究管状功能和预后标志物.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學專業.
背景情况:
- 超过50%的心力衰竭患者需要尿剂后左心室辅助装置 (LVAD).
- 关于D期心力衰竭患者的利尿反应 (DR) 的数据有限.
- 管状再吸收可能是一个独立于功能和蛋白尿的预后指标.
研究的目的:
- 在D期心力衰竭患者中,在LVAD植入之前和之后连续表征尿液反应 (DR).
- 评估LVAD植入物对管状处理和利尿疗效的影响.
主要方法:
- 前性,观察性队列研究.
- 在三个时间点测量尿中的和肌素:LVAD前,LVAD后,出院前和门诊.
- 计算部分分泌的 (FENa) 评估利尿反应.
主要成果:
- 在LVAD前,估计的淋巴细胞过率 (eGFR) 与斑点尿 (UNa) 或FENa没有相关.
- 植入LVAD并没有显著改善DR (平均变化FENa每40毫克IVfurosemide:0.5±1.0%;p=0.84).
- 90%的患者在手术后90天需要循环利尿剂.
结论:
- 在LVAD后改善的血液动力学可能不会增强利尿反应或管状功能.
- 需要进行更大规模的研究来证实这些发现,并评估DR在预测LVAD后结果中的实用性.
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