连续性肾脏替代治疗在急性下肢缺血致肌病肾病代谢综合征中的应用

Application of continuous renal replacement therapy in the treatment of myonephropathic metabolic syndrome caused by acute lower extremity ischemia

目的 总结连续性肾脏替代治疗在急性下肢缺血导致的肌病肾病代谢综合征中的应用经验.方法 回顾2008年1月至2013年12月诊断为急性下肢缺血行手术治疗的患者,其中发生肌病肾病代谢综合征行连续性肾脏替代治疗（CRRT）的患者22例.总结在治疗过程中血肌红蛋白、尿量及血肌酐等指标的变化趋势,分析患者病情变化及预后.结果 22例患者术后截肢2例,死亡2例.死亡原因主要为急性肾功能衰竭、代谢性酸中毒、循环衰竭、肝功能衰竭等.患者血肌红蛋白在术后当天（21.69±26.26）mg/L较术前（8.23±18.81） mg/L显著升高,P＜0.05,尿量在术后第1天（1 106±1 095） ml较手术当日（1 975±1 350） ml显著降低,P＜0.05,血清肌酸激酶（CK）在术后第2天（9.47±10.79） KU/L较前1天（34.22±48.41） KU/L显著降低,P＜0.05,血色素在术后当日与术前比显著降低,P＜0.05,血肌酐术后保持平稳.结论 在发生肌病肾病代谢综合征的急性下肢缺血患者中,术后早期有针对性的应用连续性肾脏替代治疗可以尽早降低血肌红蛋白水平、CK水平并改善尿量,维持内环境平稳,预防肾功能进一步恶化,期待可以改善患者预后,值得推荐.

Objective To summarize the experiences of using continuous renal replacement therapy in the treatment of myonephropathic metabolic syndrome caused by acute lower limb ischemia.Methods Retrospective study of patients diagnosed acute lower limb ischemia with surgical treatment between January 2008 and December 2013,among which 22 patients with myonephropathic metabolic syndrome received continuous renal replacement therapy.Summarize the change tendency of myoglobin,urine volume and serum creatinine levels during treatment and analysis the condition changes and prognosis of the patients.Results Among them,2 patients were amputated and two died after surgery.The major causes of death were acute renal failure,metabolic acidosis,circulation failure and liver failure,etc.Myoglobin was significantly higher at Day 1 after surgery than that was before surgery （P ＜ 0.05）.Urine volume was significantly lower at Day 1 after surgery than that on the day of surgery （P ＜ 0.05）.CK was significantly lower at Day 2 after surgery than the day before （P ＜ 0.05）.Hemoglobin was significantly lower at Day 1 after surgery than that before surgery （P ＜ 0.05）.Serum creatinine levels remained steady.Conclusion In patients of acute lower limb ischemia with myonephropathic metabolic syndrome,early targeted continuous renal replacement therapy may decrease the serum concentrations of myoglobin and CK,improve urine volume,maintain homeostasis,prevent renal function deterioration and improve the prognosis of patients.And it is highly recommended.