早期持续肾脏替代治疗热射病临床疗效分析

Effect of continuous renal replacement therapy in patients with heat stroke of early stage

目的探讨应用持续肾脏替代治疗（CRRT）治疗热射病的临床效果。方法回顾性分析2015年6月至2016年9月EICU收治的15例热射病患者。所有患者采用连续静脉-静脉血液滤过（CVVH）方法进行治疗,CVVH置换液初始温度为22-26℃,持续10-12 h,之后置换液维持36℃。监测生命体征,在CVVH治疗前后采集血样,监测血清尿素氮、肌酐、肌红蛋白、肌酸激酶、谷丙转氨酶、谷草转氨酶、动脉乳酸。结果 15例患者均痊愈出院。CRRT治疗后,患者的核心温度由（39.6±0.3）℃下降至（36.5±0.3）℃（P〈0.05）;平均动脉血压、心率、APACHEⅡ评分、氧合指数与CVVH治疗前比较,有明显改善（P〈0.05）;血清尿素氮、肌酐、肌红蛋白、肌酸激酶、谷丙转氨酶、谷草转氨酶、动脉乳酸显著降低（P〈0.05）。在CRRT治疗过程中,血流动力学稳定,无明显不良反应发生。结论 CRRT可有效降低热射病患者核心体温,清除肌红蛋白、肌酐及炎症细胞因子,支持肝肾等重要脏器功能。CRRT治疗热射病安全有效。

Objective To investigate the effect of continuous renal replacement therapy（ CRRT） in patients with heat stroke of early stage. Methods A retrospective study was performed on 15 patients with heat stroke received in EICU of The General Hospital of Shenyang Military Command from June 2015 to September 2016. All the patients were treated in continuous venous-venous hemofiltration（ CVVH） method,the substitution fluid initial temperature was maintained 22℃ - 26℃,lasted for 10 - 12 hours,then was changed into 36℃ and maintained. The vital signs were monitored,serum urea nitrogen,creatinine,myoglobin,creatine kinase,alanine aminotransferase,aspartate aminotransferase and arterial lactic acid with take samples of blood before and after CVVH treatment,respectively. Results All 15 patients recovered and discharged. Using CRRT treatment,temperature of the patients was decreased from（ 39. 6 ± 0. 3） ℃ to（ 36. 5 ± 0. 3） ℃（ P〈0. 05）. The mean arterial blood pressure（ MAP）,heart rate（ HR）,APACHE Ⅱ score and oxygenation index（ PaO2/ FiO2） were significantly improved compared with those before treatment（ P〈0. 05）. Serum urea nitrogen,creatinine,myoglobin,creatine kinase,alanine aminotransferase,aspartate aminotransferase and arterial lactic acid were significantly reduced（ P〈0. 05）. In the process of CRRT treatment,hemodynamic stability,there was no obvious adverse reaction. Conclusion CRRT can effectively reduce the body temperature,remove myoglobin,creatinine and remove inflammatory cytokines and support function of important organs such as liver and kidney. CRRT is safe and effective in the treatment of patients with heat stroke.