CRRT治疗重症中暑伴横纹肌溶解肾功能不全患者的临床评价

Clinical effect of CRRT in patients with severe heat illness complicated with rhabdomyolysis

目的评价连续肾脏替代治疗（CRRT）重症中暑伴横纹肌溶解患者的临床效果。方法选自该院2004年6月～2012年7月38例重症q-暑伴横纹肌溶解急性肾功能不全患者，分为CRRT治疗组（16例）和常规治疗对照组（22例），CRRT组在常规治疗基础上加用CRRT治疗。观察患者体温下降至38．5℃的时间、体温降至正常的时间、住院时间、死亡率及患者入院第1天、第3天、第5天血肌红蛋白、血肌酐（Cr）、尿量变化。结果两组患者在年龄、性别及病情严重程度上差异无统计学意义（P〉O．05）。CRRT组患者体温下降较对照组更为迅速（P〈O．05），住院时间显著缩短[（11．5±2．4）dVS（18．3±3．3）d]（P〈O．05），28d内治疗组3例死亡（18．7％）．而对照组9例死亡（40．9％），28d生存率明显改善（P〈0．05）；CRRT组患者第3天、第5天血肌红蛋白[（321±122）ng/mLvs（784±211）ng/mL；（226±61）ng／mLVS（638±322）ng/mL]、Cr较对照组明显下降[（168±55）μmol/LVS（288±137）μmol/L；（118±44）μmol/Lvs（237±71）μmol/L]，尿量稳定增加[（2870±386）mLvs（1782±581）mL；（3224±424）mLvs（2165±361）mL3（P〈0．05）。结论重症中暑伴横纹肌溶解肾功能不全患者，予以CRRT治疗，可以迅速降温，及时清除肌红蛋白，减轻肾损害，改善肾功能；减少住院时间，降低死亡率．改善预后．但尚需大规模前瞻临床研究证实。

[Objective] To evaluate the clinical effect of continuous renal replacement therapy （CRRT） in patients with severe heat illness complicated with rhabdomyolysis. [Methods] 38 cases of severe heat illness with rhabdomyolysis and acute renal insufficiency were selected from our hospital from June 2004 to July 2012. The patients were divided into the CRRT treatment group and the conventional treatment group （con trol）, 16 cases were given CRRT treatment in addition to conventional treatment.The duration of temperature down to 38.5℃, and to normal were recorded. Probability of survival within 28 days and the days of in hos pital were compared. Blood myoglobin, Cr and urine output at the first, third and the fifth day were also ob served. [Results] Baseline characteristics of patients were similar, such as age, score of APACHEII and body temperature at admission. Patients temperature dropped more rapidly in CRRT group than that in the control group （P〈0.05）, days in hospital in CRRT group [（11.5±2.4） d vs （18.3 ±3.3）d] were significantly shorter （P 〈0.05）. 3 patients died （18.7%） in CRRT group during 28d, while nine died in the control group （40.9%）, 28 d survival rate was significantly improved in CRRT group （P〈0.05）. Compared with the control group, at the third and the fifth day after admission, blood myoglobin protein [（321 ± 122） ng＇mL^-1 vs （784 ± 211）ng/mL;（226± 61） ng/mL vs （638 ± 322） ng/mL] and Cr [（168 ＋ 55）μmol/L vs （288 ± 137） μmol/L; （118 ± 44） μmol/L vs （237± 71）μmol/L3decreased significantly in CRRT group; urine output increased steadily [（2 870± 386）mL vs （1 782 ± 581） mL; （3 224 ± 424） mE vs （2 165 ± 361） mL3 （P〈0.05） in CRRT group. [Conclusion] In pa tients with severe heat illness complicated with rhabdomyolysis and renal insufficiency, treatment with CRRT can rapidly cool the body temperature, early removal myoglobin and other toxic metabolites, improve kidney function. It can be also shorten the days of stay in hospital and reduce mortality. But large-scale prospective clinical study should be required to confirm in future.