1 陈康寅, 李广平 (,, 300211),,,,, 3~5 mg/l 9~15 ml/min, 30%, ;,, 80 mmhg, 60 mmhg,,, ;,, / B, ; ; R59 B 1671-5403(2011)03-0000-00 Cardiorenal syndrome CHEN Kangyan, LI Guangping (Department of Cardiology, Second Hospital, Tianjin medical university, Tianjin Institute of Cardiology, Tianjin 300211, China) Abstract Cardiorenal syndrome has been defined as a state in which therapy to relieve heart failure(hf) symptoms is limited by further worsening renal function. Currently, there is no widely accepted standard for the diagnosis of cardiorenal syndrome. But some researchers have suggested that cardiorenal syndrome can be diagnosed when renal function worsens with creatinine elevation 3-5 mg/l or glomerular filtration rate decrement 9-15 ml/min. Nowadays, the exact prevalence of cardiorenal syndrome remains unclear. Some studies revealed that the incidence of cardiorenal syndrome in case of HF reached as high as 30%. The mechanisms behind cardiorenal syndrome are complex. Central venous congestion, neuroendocrine hyperactivity, anemia, oxidative stress and renal sympathetic nerve hyperactivity have been demonstrated to be important reasons causing cardiorenal syndrome. The treatment for cardiorenal syndrome remains a big challenge. The first principle of the treatment is to correct the reversible risk factors. Stable renal perfusion is also needed by sustaining systolic blood pressure over 80 mmhg or mean blood pressure over 60 mmhg. For those with low cardiac output, nitrates might be helpful. Further, medications with renal toxicity should be withdrawn timely. Diuretics, angiotensin converting enzyme inhibitor/angiotensin receptor blocker, hemofiltration, recombinant human B-type natriuretic peptide can be used as appropriate choice. Key words cardiorenal syndrome; heart failure; renal insufficiency This work was supported by Fund for Talents in New Century of Tianjin Medical University,,, 2004, 1 2004, 收稿日期 : 2011-02-17; 修回日期 : 2011-04-30 基金项目 :. 通讯作者 :, Tel: 022-88328649, E-mail: tjcardiol@126.com
2 中华老年多器官疾病杂志 2011 年 6 月 28 日第 10 卷第 3 期 Chin J Mult Organ Dis Elderly, Vol.10, No.3, Jun 28, 2011 :,, [1],, Ronco [2], :,, 2 Ronco [2] 5 1Ronco,,,,,, Ronco, [3] 2, 3, 1 Ronco [2] 2 [3],, 3,, Ronco [2],, [1],, Acute Decompensated Heart Failure National Registry, ADHERE [4] 105 000, 30%, 21% 20 mg/l, 9% 30 mg/l McAlister [5] 754, 17% 90 ml/min, 31% 39%, NYHA 30 ml/min 4, [6],, ; [1,7] Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness, ESCAPE [8] 433, ; ; Mullens [9],, [10] 3,, 5,
3 表 3 [10] 心肾综合征的危险因素 () : () (angiotensin converting enzyme inhibitor, ACEI) ( ) (angiotensin receptor blocker, ARB) ( I T) ( C ), : 3 mg/l [11],, Francis [12] : 60 ml/ mim 2 Tang [10] : 3~5 mg/l 9~15 ml/min, 6 ACEI ARB [13],, ACEI ARB 6.1,, ACEI ARB ;,,, 80 mmhg, 60 mmhg,, [14],,,,,,,,, 6.2 6.2.1, - - renin angiotensin aldosterone system, RAAS,,, 2~4, [15],,, [2] Dose Optimization Strategy Evaluation, DOSE) [16] 2 2, 4 6.2.2 ACEI ARB ACEI ARB ACEI ARB,, ACEI ARB,,, [17],,, ACEI ARB, 6.2.3 14~15 ml/min, RAAS, [7],, Intravenous Diuretics for Patients Hospitalized for Acute Decompensated Congestive Heart Failure, UNLOAD),,
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