盐酸戊乙奎醚联合CRRT对横纹肌溶解所致急性肾损伤的疗效

Treatment on acute renal injury induced by rhabdomyolysis with Pentenehyclidine hydrochloride combined with CRRT

目的研究盐酸戊乙奎醚联合持续肾脏替代疗法(CRRT)对横纹肌溶解所致肾损伤的治疗作用。方法选择横纹肌溶解所致急性肾损伤患者50例,随机分为盐酸戊乙奎醚治疗组(以下简称观察组)和对照组。观察组(n=25):每天行CRRT 8 h+常规治疗的基础上,加常规剂量盐酸戊乙奎醚0. 01 mg/kg,肌肉注射,1次/d。对照组(n=25):每天行CRRT 8 h+常规治疗,分别测定第1次给药前1 h,治疗24 h后,48 h后,5 d后的生化指标:肌红蛋白(MB)、肌酸激酶(CK)、乳酸脱氢酶(LDH)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、血肌酐(Scr)、尿素氮(BUN)及血清炎症相关因子C反应蛋白(RP)、白细胞介素-6(IL-6);监测心率(HR)和平均动脉压(MAP)及患者住院时间,肌肉溶解复发率及患者转归情况。结果组内比较,观察组在治疗24 h、48 h、5 d的生化指标MB、CK、LDH、AST、ALT、Scr、BUN较治疗前均明显降低(P <0. 05);炎症指标CRP、IL-6均较治疗前明显降低(P <0. 05); HR、MAP均较治疗前明显降低(P <0. 05)。对照组在治疗24 h、48 h、5 d的生化指标MB、CK、LDH、AST、ALT、Scr、BUN较治疗前均明显降低(P <0. 05); HR、MAP均较治疗前明显降低(P <0. 05);炎症指标CRP、IL-6在治疗48 h、5 d均较治疗前明显降低(P <0. 05),在治疗24 h时间点无明显变化。组间比较,在治疗24 h、48 h、5 d的时间点,观察组各项生化指标MB、CK、LDH、AST、ALT、Scr、BUN均较对照组明显降低(P <0. 05);观察组炎症指标CRP、IL-6均较对照组降低明显(P <0. 05)。观察组的HR较对照组无明显差异(P> 0. 05),观察组的MAP较对照组有明显降低(P <0. 05)。观察组患者住院时间(8±3) d,较对照组(15±6) d明显减少(P <0. 05);观察组肌肉溶解无一例复发,复发率为0,对照组为4例复发,复发率为16%;观察组1例死亡,病死率为4%,对照组3例死亡,病死率12%,观察组死亡率较对照组明显下降(P <0. 05)。结论盐酸戊乙奎醚联合CRRT对横纹肌溶解所致急性肾损伤可明显改善患者各项生化指标及炎症指标,减少患者的住院时间、复发率及病死率,治疗期间注意监测血压,心率。

Objective To study the therapeutic effect of penehyclidine hydrochloride combined with CRRT on renal injury induced by rhabdomyolysis. Methods Fifty patients with acute renal injury caused by rhabdomyolysis were randomly divided into two groups,penehyclidine hydrochloride treatment group and control group. Continuous renal replacement therapy( CRRT) was performed on the basis of routine treatment for 8 hours,plus routine dose of pentylephrine hydrochloride( 0. 01 mg/kg,im,QD) in pentaniline hydrochloride treatment group. Daily continuous renal replacement therapy( CRRT) for 8 hours plus conventional treatment were performed in control group. The biochemical indexes,including MB,Ck,LDH,ALT,AST,Scr and serum inflammation-related factor CRP,IL-6,were measured 1 hour before the first administration,24 hours after treatment,48 hours after treatment,and 5 days after treatment. Heart rate,mean arterial pressure( MAP),average hospital stay,myolysis recurrence rate and outcome were monitored. Results In treatment group,24 h,48 h and 5 days after treatment,MB,CK,LDH,AST,ALT,Scr and BUN were significantly lower than those before treatment( P < 0. 05);inflammation indexes( CRP,IL-6) were significantly lower than those before treatment;and heart rate and mean arterial pressure were also significantly lower than before treatment( P < 0. 05). In control group,MB,CK,LDH,AST,ALT,Scr and BUN 24 h,48 h and 5 days after treatment were significantly lower than those before treatment( P < 0. 05);heart rate and mean arterial pressure were also significantly lower than those before treatment( P < 0. 05);CRP and IL-6 48 h and 5 days after treatment were significantly lower than those before treatment. Compared with the control group,the MB,CK,LDH,AST,ALT,Scr and BUN of the treatment group were significantly lower than those of the control group( P < 0. 05),so were the CRP and IL-6( P < 0. 05). The heart rate of the treatment group was not significantly different from that of the control group. The mean arterial pressure was significantly lower in treatment group than that in the control group( P < 0. 05). The hospital stay of treatment group was( 8 ±3) days,which was significantly shorter than that of the control group( 15 ± 6) days. There was no recurrence in the treatment group while there were 4 cases in the control group( 16%). One case died in the treatment group,and the mortality was 4%. In the control group,3 cases died,and the mortality rate was 12%. The mortality rate in the treatment group was significantly lower than that in the control group( P < 0. 05). Conclusion Acute renal injury induced by rhabdomyolysis is significantly improved by pentanethaqualone hydrochloride combined with CRRT,and the duration of hospitalization,recurrence rate and mortality are reduced.