烧伤合并急性肾功能衰竭的临床研究

Clinical study of early indicators of acute renal failure in burned patients

目的：探讨烧伤合并急性肾功能衰竭（ARF）的早期指标检测以及各种危险因素和疗效。方法：选择2008年1月～2009年6月所收治的中重度热烧伤患者75例，Ⅱ度或Ⅲ度烧伤面积累计达20％～70％TBSA。所有患者在入院时、入院后3d、7d、14d和21d检测血清肌酐（Scr）、血尿素氮（BUN）、肌酐清除率（Ccr）、24h尿量、尿蛋白、尿微量白蛋白（mALB）。结果：75例烧伤患者中有14例（18．7％）并发ARF。烧伤合并ARF组平均Scr、Ccr和尿蛋白水平在住院7d后明显高于烧伤未合并ARF组（P均〈0．05），平均BUN水平在住院14d后明显高于烧伤未合并ARF组（P〈0．05），平均尿量在住院21d后明显高于烧伤未合并ARF组（P〈0．05）。烧伤合并ARF组在入院时mALB水平已达正常值3-4倍，在观察期均高于烧伤未合并ARF组（P均〈0．05）。烧伤面积与脓毒症是烧伤并发ARF的主要危险因素（负相关系数r分别为0．52和0．23，P均〈0．05）。14例ARF患者中有10例患者行血液净化治疗，其他4例患者给予相应治疗。12例患者痊愈，2例患者（14.3％）分别死于严重脓毒症和多器官功能衰竭。结论：本组资料显示．mALB是早期监测ARF的敏感指标，烧伤合并ARF与烧伤面积与脓毒症相关，连续性静脉－静脉血液滤过（CVVH）治疗烧伤合并ARF疗效较好．

Objective： To determine the predictors of acute renal failure （ARF） that occur in major bums. Methods： The data of 75 patients with moderate to severe thermal bum injury of second to third degree with 20%-70% of total body surface area （TBSA） in our hospital were analyzed. All patients were subjected to routine investigations which included serum creatinine （Scr）, blood urea nitrogen （BUN）, creatinine clearance rate （Ccr）, 24 h urine volume, total urinary protein, urinary microalbuminuria （mALB） on admission, 3, 7, 14 and 21 clays later of hospitalization. Results： 14 patients （18.7%） developed ARF. The levels of Scr, Ccr and urinary protein in group with ARF from 7 days later were obviously higher than that in group without ARF （P〈0.05）. The levels of Bun in group with ARF from 14 days later were obviously higher than that in group without ARF （P〈0.05）. The levels of 24 h urine volume in group with ARF from 21 days later were obviously higher than that in group without ARF （P〈0.05）. The group with ARF showed an increase level of mALB that reached 3-4 folds above its normal level on admission and it was obviously higher than that in group without ARF in the period of ob servation （P〈0.05）. Burn size and occurrence of septicemia were the only risk factor of ARF using multiple regression analysis （r=0.52, 0.23. P〈0.05）. 10 out of the 14 cases required blood purification therapy, other 4 patients were given appropriate treatment. 12 cases were cured, 2 patients （14.3%） died of severe sepsis and multiple organ failure respectively. Conclu- sion： In this study, ARF is related to the size of burn and occurrence of septicemia, mALB is an useful early indicator for prediction of renal outcome. The treatment of burns combined with ARF by CVVH is effective.