持续床旁血液净化联合削痂治疗重度烧伤并发ARF

Treatment of severe burn complicated by ARF with continuous bedside blood purification combined with eschar excision

目的观察持续床旁血液净化联合早期削痂植皮对重度烧伤并发急性肾功能衰竭（ARF）的治疗疗效。方法以我院2011年1月-2013年12月收治的23例重度烧伤并发ARF患者为研究对象,入院后给予积极补液抗休克、纠正电解质紊乱、抗感染、早期削痂植皮及持续床旁静脉-静脉血液透析滤过等综合治疗。检测患者治疗前,治疗后1、3、7、14、21 d血生化指标、炎症因子的变化及治疗疗效。结果治疗后3 d开始,患者Hb、WBC、Scr、ALT、AST、血钾、TNF-α及IL-6与治疗前相比明显降低,尿量明显增多（P〈0.05）;治疗后7 d开始,BUN及m ALB与治疗前相比也明显降低（P〈0.05）,IL-10与治疗前相比明显增高（P〈0.05）。所有患者经过积极综合治疗无死亡病例,早期削痂植皮存活率为（96.1±3.8）%,患者住院时间（31.5±8.2）d10治疗后5-20 d进入多尿期,平均（10.2±5.0）d,肾功能均恢复正常。结论持续床旁血液净化联合早期削痂植皮等综合治疗,可有效纠正重度烧伤并发ARF患者的内环境紊乱,恢复肾功能,临床疗效确切。

Objective To observe the curative effect of continuous bedside blood purification combined with early tangential excision of eschar and skin grafting in the treatment of severe burn complicated by acute renal failure（ ARF）. Methods Total 23 patients who were suffering from severe burn complicated by ARF and receiving treatment in our hospital from Jan. 2011 to Dec. 2013 were selected for the research. After the admission,they were provided with comprehensive treatment including anti-shock rehydration,correction of electrolyte imbalance,anti-infection treatment,early tangential excision of eschar and skin grafting,and continuous bedside veno-venous hemodiafiltration etc. The blood biochemical indexes,change of inflammatory factors and treatment efficacy before the treatment and those after treatment for 1,3,7,14,21 d were examined,respectively. Results After treatment for 3 d,Hb,WBC,Scr,ALT,AST,serum potassium,TNF-α and IL-6 of the patients decreased significantly in comparison with those before the treatment,and urine volume increased significantly（ P〈 0. 05）; after treatment for 7 d,BUN and m ALB also decreased significantly and IL-10 increased significantly in comparison with that before the treatment（ P〈 0. 05）. After the active comprehensive treatment,no deaths in the cases,and the survival rate of early tangential excision of eschar and skin grafting was（ 96. 1 ± 3. 8） %; the hospitalization time period of the patients was（ 31. 5 ± 8. 2） d. In 5-20（ 10. 2 ± 5. 0） d since the treatment,the diuresis stage came and the renal function became normal. Conclusion Continuous bedside blood purification combined with early tangential excision of eschar and skin grafting and other comprehensive treatments,can effectively correct the internal environment disorder and recover the renal function of the patients with severe burn complicated by ARF,with definite clinical curative effect.