早期应用连续性血液净化治疗危重型肾病综合征出血热的临床分析

Clinical analysis of continuous blood purification therapy on patients with severe hemorrhagic fever with renal syndrome

目的探讨连续性血液净化（continuous blood purification，CBP）在危重型肾病综合征出血热（hemorrhagic fever with renal syndrome，HFRS）的临床治疗效果。方法回顾分析解放军第三医院肾脏内科近2年收治的24例危重型HFRS患者在治疗原发病的基础上，均给予CBP治疗，采用连续性静脉一静脉血液滤过（continuous veno-venous hemofiltration，CVVH）或连续性静脉一静脉血液透析滤过（continuous veno-venous hemodiafiltration，CVVHDF），持续治疗时间不少于24h。比较患者治疗前后血白细胞（WBC）、血小板（PLT），动脉血气分析、二氧化碳结合力（C02CP），C反应蛋白（CRP），血尿素氮（BUN）、血肌酐（SCr）、血清丙氨酸氨基转氨酶（ALT）、天冬氨酸氨基转氨酶（AST）、部分活化凝血活酶时间（APTT）的变化。结果24例危重型HFRS患者经CBP治疗后12～48h的PLT、动脉血气pH值、C02CP显著提高（P〈0．05），WBC、CRP、BUN、SCr、ALT、AST、部分活化凝血活酶时间降低（P〈0．01）。结论对于危重型HFRS患者给予早期积极CBP干预治疗可稳定血流动力学、迅速改善内皮细胞功能紊乱的全身炎症状态，为补液、营养支持及后续的药物治疗创造条件，能获得满意疗效。

Objective To determine the clinical effectiveness of continuous blood purification （CBP） therapy on severe hemorrhagic fever with renal syndrome （HFRS） patients. Methods Twenty- four patients who developed severe FHRS between 2011 and 2012 in The Third Military Hospital were reviewed retrospectively. In addition to routine treatments, all of the patients performed CBP at least 24 h with GAMBRO Prismaflex machine. The clinical manifestations and biochemical indicator, as blood white blood cell （WBC）, platelet （PLT）, arterial blood gas analysis, carbon dioxide combining power （CO2 CP）, blood urea nitrogen （BUN）, serum creatinine （SCr）, unic acid （UA）, ALT, AST, ac- tived partial thromboplastin time （APTT） and e-reactive protein （CRP）, were compared between pre- therapy and post-trenment. Results The twenty-four patients had significant improvement clinical manifestations, such as elevation of PLT and arterial pH and CO2 CP （P〈0. 05）, decrease of WBC, BUN,SCr,UA,ALT,AST,APTT and CRP （P〈0. 05）. Conclusions CBP therapy as an early inter- vention can bring significant benefits to severe HFRS patient with systemic inflammatorome, such as stabilize hemodynamics, improve the abnomality of endothelial cell functions, and create the condition of fluid replacement, nutritional support and drug treatment.