洗腎患者的心衰竭

最近一位圈內大老說他心衰竭只剩下LVEF 20幾,歸咎於當初談透析總額的時候陪喝酒喝太多,雖然我記得去年年會看到他感覺還蠻勇的,不過真的很辛苦,為了從健保局手上要到應有的給付,還得付出自己健康,無論如何,respect。

這讓我聯想到其實很多洗腎患者也都有心臟衰竭的問題,
在這篇review
Managing Heart Failure in Patients on Dialysis: State-of-the-Art Review

大約一半的心力衰竭 (HF) 患者同時患有慢性腎髒病 (CKD)。同樣,高達 70% 的 CKD 患者和 36% 的需要透析的終末期腎病 (ESKD) 患者患有心衰竭。雖然這兩個同時存在的病因會使預後變差,但由於很多研究收案都會先將這兩個不好的因子排除在外,所以一些治療指引也很難告訴我們應該怎麼做最好。

作者貼心的把所有的療法做成一張簡單的圖表總結了一下,看來beta blocker 是比較好的選擇。很夯的ARNI 像Entresto,雖然大家都說好,可是我手上幾個老年患者吃了就是血壓直直落,即使已將降低劑量但根本沒辦法脫水,這樣對於心衰竭無疑雪上加霜。

Heart Failure Management in Dialysis Patients: Many Treatment Options with No Clear Evidence

這篇列出的方法也是大同小異,問題都在於收案限制所以樣本都不夠多,沒人敢跟你保證哪個最安全有效。

EECP體外反搏治療 心衰竭阿嬤回復生命力

然後我看到了這篇,問了一下BARD,GOOGLE的AI看看這東西能用在洗腎患者身上嗎? 回答是:

Yes, ECCP (External Counterpulsation) can be useful in hemodialysis patients with heart failure.

ECCP is a non-invasive therapy that uses pneumatic cuffs to apply pressure to the lower extremities during hemodialysis. This pressure helps to increase blood flow to the heart and lungs, and can help to improve symptoms of heart failure.

A 2017 study published in the journal Nephrology Dialysis Transplantation found that ECCP was effective in reducing mortality and hospitalization rates in hemodialysis patients with heart failure. The study also found that ECCP improved quality of life and exercise capacity in these patients.

Another study, published in the journal Journal of the American Society of Nephrology in 2018, found that ECCP was effective in reducing the risk of hospitalization for heart failure in hemodialysis patients. The study also found that ECCP improved exercise capacity and quality of life in these patients.

ECCP is a safe and effective therapy for hemodialysis patients with heart failure. It can help to improve symptoms, reduce the risk of hospitalization, and improve quality of life.

If you are a hemodialysis patient with heart failure, talk to your doctor about whether ECCP is right for you.

Here are some of the benefits of ECCP in hemodialysis patients with heart failure:

  • Reduces mortality and hospitalization rates
  • Improves quality of life and exercise capacity
  • Safe and effective

If you are interested in learning more about ECCP, please talk to your doctor.

可是連EECP都打成ECCP這個回答可信嗎? 會不會跟chatgpt一樣是瞎掰的? 所以再用Google找一下是不是真的有這些文章。結果還真的有,當然樣本數一樣很少,在台灣應該也不多,畢竟一次4000,做個療程幾十次,也不是每個人都負擔得起。不過詢問有經驗的醫師回答是透析中比較不容易掉血壓,而且非侵入性感覺也算安全。或許可以提供給患者一個選擇,如果經濟負擔得起的話。

在〈洗腎患者的心衰竭〉中有 1 則留言

  1. 後來又找到
    https://rrtjournal.biomedcentral.com/articles/10.1186/s41100-023-00473-4
    日本診所只有兩名病患

    https://www.frontiersin.org/articles/10.3389/fcvm.2022.955780/full
    鄭州大學有247名這個樣本比較可信,但是居然都說沒有副作用,難道這些人都不會掉血壓,我相信對於超音波的數字一定有改變,但沒有一個有副作用我是懷疑

    https://www.ahajournals.org/doi/10.1161/JAHA.122.026407
    這篇是北榮的,時間比較長觀察了一年,有800多個患者接受心臟超音波挑出61個LVEF<40的分成兩組,沒想到還吃到200mg 一天兩次。但是一樣很神奇的沒發現有掉血壓的情況。

    難道是我這邊風水不好,老的小的吃了血壓都掉到不行?

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