早期清创联合解毒剂治疗铬酸烧伤并发急性肾损伤一例

Early debridement combined with antidote in the treatment of one patient with chromic acid burn and acute kidney injury

患者男,52岁,2018年11月16日因"右下肢热化学溶液烧伤1 h"收入苏北人民医院,烧伤总面积达9%体表总面积(TBSA),其中Ⅱ度7%TBSA、Ⅲ度2%TBSA。入院后给予抗感染、镇痛、补液等处理。11月19日患者出现恶心、呕吐及少尿等症状,相关实验室检查提示急性肾损伤,立即予以连续性肾脏替代治疗,分次于11月20日和27日进行切、削痂及扩创、皮片移植手术治疗,并应用特效解毒剂等处理。经积极治疗后,患者病情平稳,2个月后痊愈出院,出院后随访5个月未见明显异常。该病例提示临床医师应加强对铬酸烧伤的认识,尤其对合并热损伤的患者,伤后要及时有效地进行创面处理,密切监测肝肾功能及血铬浓度变化,及早辅助应用解毒剂。

On November 16,2018,one male patient,aged 52 years was admitted to Northern Jiangsu People′s Hospital due to thermal chemical burn to the right lower limb for 1 hour.The total burn area reached 9%total body surface area(TBSA),including 7%TBSA of partial-thickness burn and 2%TBSA of full-thickness burn.After admission,the patient was treated with anti-infection,analgesia,fluid infusion.On November 19,the patient developed symptoms such as nausea,vomiting,and oliguria,the related laboratory examination showed acute kidney injury,and the patient was immediately treated with continuous renal replacement therapy.Eschar excision,eschar cutting and shaving,skin grafting were performed on 20 and 27 November,and the specific antidote was applied.After active treatment,the patient′s condition was gradually stable and recovered,and he was discharged 2 months later.There was no obvious abnormality during follow-up of 5 months after discharge.This case reminds that clinicians shall strengthen the understanding of chromic acid burns,especially for the patient combined with thermal burns,timely and effective treatment of wounds after burns,close monitoring of liver and kidney function and blood chromium concentration,and early application of antidote are necessary.