连续性静-静脉血液滤过在重度烧伤合并急性肾损伤患者中的应用

Continuous veno-venous hemofiltration in severe burn patients with acute kidney injury

目的探讨连续性静-静脉血液滤过(CWH)治疗重度烧伤合并急性肾损伤(AKI)患者的疗效。方法将45例2008年1月—2012年12月在上海长海医院烧伤科重症监护病房(ICU)接受治疗的重度烧伤合并AKI患者分入CWH组(23例)及常规治疗组(22例),常规治疗组仅予常规治疗,CWH组在常规治疗的基础上进行CWH。观察治疗前后两组患者心率(HR)、平均动脉压(MAP)、动脉血氧分压(paO2)、急性生理学及慢性健康状况评分(APACHEⅡ评分)及血清肌酐(sCr)、尿素氮(BUN)、血钾、血钠、血糖的变化。结果 CWH组治疗后的HR、APACHEⅡ评分均较治疗前显著降低(P值均<0.05),paO2较治疗前显著升高(P<0.05);常规治疗组治疗前后MAP、HR、paO2、APACHEⅡ评分的差异均无统计学意义(P值均>0.05)。CWH组治疗后BUN、sCr、血钠、血钾、血糖水平均较治疗前显著下降(P值均<0.05),常规治疗组治疗前后上述各项指标的差异均无统计学意义(P值均>0.05)。常规治疗组患者的病死率(27.3%)显著高于CWH组(13.1%,P<0.05)。结论重症烧伤合并AKI患者行CWH后血流动力学较稳定,治疗后各项实验室指标好转;CWH是救治重症烧伤合并AKI患者的有效措施之一。

Objective To investigate the efficacy of continuous veno-venous hemofiltration （CWH） in severe burn patients with acute kidney injury （AKI）. Methods From January 2008 to December 2012, 45 patients with severe burns complicated by AKI received treatment in intensive care unit （ICU） in Changhai Hospital. They were divided into CWH group （n = 23） and conventional treatment group （n = 22）. All patients were treated by conventional treatment. Furthermore, the patients in CWH group received continuous blood purification. Vital signs and laboratory parameters, such as heart rate （HR）, mean arterial pressure （MAP）, arterial partial pressure of oxygen （paO2）, acute physiology and chronic health evaluation （APACHE） II score, creatinine （sCr）, urea nitrogen （BUN）, and serum sodium, potassium, and glucose levels were observed before and after treatments. Results In the CWH group, compared with before treatment, HR and APACHE II score were significantly decreased and paO2 was significantly increased after treatment （all P〈O. 05）. There were no significant differences in MAP, HR, paO2 or APACHE II score in the conventional treatment group before and after treatment （all P〉O. 05）. BUN, sCr, serum sodium, potassium, and glucose levels in the CWH group were significantly lower after treatment than before treatment （all P〈O. 05） ; but there were no significant differences in these indicators in the conventional treatment group （all P〉0.05）. Mortality in the conventional treatment group was significantly higher than that in CWH group （27.3% vs. 13.1%, P〈O. 05）. Conclusion During continuous blood purification, hemodynamics are stable and the laboratory indicators are improved in the severe burn patients with AKI. It is one of the effective measures to treat severe burns complicated by AKI. （Shanghai Med J, 2013, 36： 209-212）