连续性血液净化治疗部队官兵热射病的疗效观察

Effect of Continuous Blood Purification in Mmilitary Servicemen with Heat Stroke

目的探讨连续性血液净化在21名部队官兵训练后所致的热射病（heat stroke,HS）的应用。方法回顾分析2005-01/2014-01月作者医院收治的21例HS部队官兵,分为两组：连续性血液净化（continuous blood purification,CBP）组8例（CBP组）,一般治疗组13例（常规组）。入院后两组均给予物理降温、抗休克、维持水电解质平衡、镇静、脱水、脑组织保护剂以及保护各组织脏器等综合治疗。CBP组另采取连续性静-静脉血液滤过（continuous veno-venous hemodiafiltration,CVVH）治疗模式,置换液流量为2500~3000 ml/h,置换液均不加热,置换液中根据病情增加等量的新鲜冰冷血浆,血流量为250~300 ml/min,均采用无肝素,生命体征平稳后24 h停CBP。并选择1个月,3个月,6个月后进行随访。结果两组患者均治愈出院。CBP组体温（temperature,T）、血小板（platelet,PLT）、凝血酶原时间国际标准化比值（prothrombin time international normalized ratio,INR）、肌酐（creatinine,Cr）、肌酸激酶（creatine kinase,CK）、丙氨酸氨基转移酶（alanine transaminase,ALT）6项指标在经过CBP治疗72 h后,均明显好转,与常规组比较有统计学意义（P〈0.05）。7天后两组在T、PLT、INR比较上差异无统计学意义（P〉0.05）,但Cr、CK、ALT比较差异有统计学意义（P〈0.05）。治愈1个月,3个月,6个月后随访发现两组在T、PLT、INR、Cr、CK、ALT均无统计学意义。结论 CBP在治疗HS时对改善肝肾功能、预防横纹肌溶解和弥散性血管内凝血的发生以及控制体温均有较好的作用。

Objective To explore the effect of continuous blood purification （CBP） in military servicemen with heat stroke.Methods A retrospective analysis of 21 military servicemen with heat stroke during January 2005 to January 2013 was performed. Eight cases taking CBP were CBP group, the flow rate of liquid displacement was 2500-3000 ml/h, the liquid displacement was not heat, the flow rate of blood was 250- 300 ml/min, equal amount of fresh frozen plasma was added during the liquid displacement according to the disease status, no heparin was supplied, and CBP were stopped 24 hours after the stable vital signs. Another 13 cases were conventional group accepting the conventional treatment including temperature decreasing, antishock, sedation, deprivation, brain tissue protection and electrolyte balance maintenance.The patients were followed up at 1,3, and 6 month.Results All the patients were cured and discharged. 72 hours after CBP treatment, the temperature （T）, platelet （PLT）, prothrombin time international normalized ratio （INR）, creatinine （Cr）, creatine kinase（CK） and alanine transaminase （ALT） of the two groups were improved significantly in CBP group and better than conventional group （P〉0.05）. Seven days after treatment, Cr, CK and ALT were significantly different between two groups （P〈0.05）.During the follow up, all the indexes were not significantly different between two groups. Conclusion CBP can improve the function of liver and kidney, prevent rhabdomyolysis and disseminated intravascular co agulation, reduce the high temperature.