Efficacy Of CRRT In The Treatment Of Patients With Different Types Of Ejection Fraction And Heart Failure With Renal Insufficiency

Objective:Heart failure is a common clinical disease,often prolonged,and symptoms often recur.Although the basic and clinical research on heart failure continues to deepen in recent years,medical technology is changing with each passing day,and new drugs and device treatments are increasingly used in patients with heart failure,but it is still difficult to cure[1].A large number of studies have found that patients with heart failure have a higher incidence rate,and after treatment,the patient's treatment is not effective due to various reasons,and the disability rate and mortality rate remain high.Due to the disease,the patient's mental burden is heavier,often accompanied by varying degrees of anxiety and depression.With the continuous development of the disease,the patient's activity tolerance gradually declines,the treatment effect is worse,and the quality of life of the patient is further reduced[2].Renal dysfunction is also common with heart failure,and studies have shown that this ratio is about 25%.Heart failure patients with renal insufficiency have a higher incidence of diuretic resistance,which will make clinical treatment more difficult and more complicated.Continuous Renal Replacement Therapy(CRRT)technology has been used in clinical applications for many years,with mature technology and effective curative effect.Early CRRT was mainly used in the field of kidney disease and critical illness.Due to its diversity of treatment methods and its small impact on hemodynamics,it has gradually emerged in the cardiovascular field in recent years,saving the lives of countless patients.A large number of clinical studies have confirmed that CRRT technology is an effective treatment for patients with heart failure and volume overload,from the basic and clinical perspectives.The clinical effect is clear,the complications are few and the prognosis can be improved to varying degrees.In recent years,people's research on heart failure has continued to deepen,and the understanding of diseases has been continuously improved.The new classification of heart failure based on left ventricular ejection fraction(LVEF)has been widely recognized by scholars around the world.The clinical basis,clinical manifestations and prognosis of patients with heart failure with different ejection fractions are quite different,but most of them have capacity overload.Whether CRRT has different clinical outcomes and prognosis for different ejection fractions,especially those with renal insufficiency,is still unclear,and there are few related clinical studies.This study analyzed the changes in CRRT applied to patients with different ejection fractions of heart failure and renal insufficiency,and explored the efficacy and prognosis of CRRT in the treatment of patients with different types of ejection fraction and heart failure with renal insufficiency.The difference will provide some help for better individualized treatment of patients with heart failure in the future.METHODS: Patients who underwent hospitalization for cardiovascular failure in the First People's Hospital of Zhangzhou City from December 2016 to December 2017 due to heart failure and renal insufficiency were selected.All patients were treated with standardized medical treatments including the “Golden Triangle”(eg no contraindications)based on treatment guidelines.CRRT was given to improve the volume load based on the above medical treatment.A total of 66 patients were enrolled,aged 40 to 91 years,including 22 male patients and 44 female patients.The LVEF of each patient was measured at the beginning of the study,and the enrolled patients were divided into two groups according to the LVEF level before CRRT treatment,33 patients with LVEF retention group(LVEF ? 50%)and LVEF reduction group(LVEF < 50%).33 cases.The CRRT treatment time,the total amount of ultrafiltration fluid,the length of hospital stay,the number of CRRT,and the treatment mode were analyzed.The differences in CRRT intensity between the two groups were compared.By measuring the patient's CRRT before treatment and 6minutes after the end of treatment,walking test,mean arterial pressure(MAP),heart rate(HR),N-terminal B-type natriuretic peptide(NT-pro BNP),LVEF,serum C-reactive protein(CRP)Creatinine(Cr)index,and calculated the total effective rate of each group,and evaluated the difference in clinical efficacy between the two groups of patients with different ejection fractions after CRRT was applied to patients with heart failure.The patients were followed up to 30 days after discharge,and the30-day rehospitalization rate and 30-day all-cause mortality were the primary endpoints.The prognosis of the two groups was compared.The related short-term complications and adverse reactions were recorded during the CRRT process,and the differences between the two groups were compared to evaluate the safety of CRRT.RESULTS: There were no significant differences in CRRT treatment time,CRD treatment time,treatment mode and hospitalization time between the two groups(P>O.05).There was no significant difference in MAP between the two groups before and after treatment(P>0.05),but the difference of 6-minute walking test,NT-pro BNP,CRP,Cr,LVEF was statistically significant(P<0.05).There was no significant difference in the difference between CRP and Cr(P>0.05),but the difference between the 6-minute walk test and NT-pro BNP and LVEF was statistically significant(P<O.01).The total effective rate was 90.91% in the LVEF-reduced group and87.88% in the LVEF-retained group.There was no significant difference in the efficacy(P>0.05).There was a difference in the re-hospitalization rate and all-cause mortality between the two groups within 30 days.There was no statistical significance(P>0.05);all patients had no serious complications such as catheter-related blood infection,obvious skin mucosa or organ bleeding,severe hypotension,and imbalance syndrome.Adverse reactions in the LVEF-reduced group included 3 cases of hypotension and 2 cases of local oozing at the puncture site.The adverse reactions of the LVEF-retained group included 1 case of hypotension and 3cases of local oozing at the puncture site,but the difference between the two groups was not statistically significant(P>0.05).Conclusion: CRRT technology is applied to patients with heart failure and renal insufficiency,which can significantly reduce the capacity overload of these patients,and the treatment effect is positive,and the clinical adverse reactions are mild.Compared with patients with heart failure and renal insufficiency retained by LVEF,CRRT technique may have better clinical outcomes in patients with reduced LVEF,but there is no significant difference in short-term prognosis between the two groups.