早期血液滤过对挤压综合征所致急性肾功能不全预后的影响

Effect of Earlier Period Hemofiltration on Prognosis of Acute Renal Faliure caused by Crush Syndrome

目的 探讨早期血液滤过对挤压综合征所致急性肾功能不全预后的影响。方法 对 2 7例挤压综合征患者分别测定 2 4h内的血肌红蛋白 (MYO)及肌酸激酶 (CK)浓度 ,根据创伤严重度评分 (AIS ISS)及血肌红蛋白浓度分为 3组 :Ⅰ组 11例 ,AIS ISS <16 ,MYO <10 0 0ng/mL ;Ⅱ组 10例 ,AIS ISS >16 ,MYO >10 0 0ng/mL ,未行血液滤过治疗 ;Ⅲ组 6例 ,AIS ISS >16 ,MYO >10 0 0ng/mL ,创伤后 4 8h内即行血液滤过治疗。动态监测每位患者的肾功能 :血尿素氮 (BUN)、肌酐 (Cr)指标。结果 Ⅰ组无一例发生急性肾功能不全 ,全部治愈 ;Ⅱ组均发生急性肾功能不全 ,全部死亡 ;Ⅲ组均未发生急性肾功能不全 ,除一人死于迟发性脑出血外全部治愈。结论 血肌红蛋白浓度可以作为挤压综合征所致急性肾功能不全的预测指标 ;早期血液滤过可以避免急性肾功能不全的发生 ,改善预后。

Objective To research effect of earlier period hemofiltration on prognosis of acute renal faliure caused by crush syndrome.Methods Measuring the concentration of serum myoglobin (MYO) and creatine kinase (CK) in 24 hours on admission;according to injury severe degree—AIS-ISS,dividing 27 patients into three groups:Ⅰ group,11 patients,AIS-ISS<16 ,MYO<1 000ng/mL;Ⅱ group,10 patients,AIS-ISS>16,MYO>1 000ng/mL,without hemofiltration;Ⅲ group,6 patients,AIS-ISS>16,MYO>1 000ng/mL ,with hemofiltration in 48 hours after trauma.Dynamic monitoring the concentration of blood urea nitrogen (BUN) and serum creatinine of every patient.Results No one developed acute renal failure in groupⅠ,every patient restored health;Every patient developed acute renal failure and died in group Ⅱ;No one developed acute renal failure in group Ⅲ,every patient restored health except a patient died of cerebral hemorrhage.Conclusion The MYO level may be an index of forecasting acute renal failure caused by crush syndrome;earlier period hemofiltration can avoid if developing to acute renal failure,improve the prognosis.