连续性肾脏替代治疗联合血液灌流在重症蝰蛇咬伤患者中的应用

Evaluation of continuous renal replacement therapy in combination with hemoperfusion in critically ill patients with viper bite

目的:探讨连续性肾脏替代治疗(CRRT)联合血液灌流(HP)在重症蝰蛇咬伤患者中的应用效果。方法:回顾性分析2018年1月至2021年1月收治的38例重症蝰蛇咬伤患者的临床资料,根据采用的血液净化治疗方法不同分为对照组和观察组。两组患者在毒蛇咬伤常规治疗的基础上,观察组采用连续性静脉-静脉血液滤过联合血液灌流的方式进行治疗,对照组采用连续性静脉-静脉血液滤过的方式进行治疗。比较两组患者在血液净化治疗72 h及7 d后的肝功能、肾功能、凝血功能、血常规等指标的变化,以及患者平均机械通气时间、住院时长。结果:治疗72 h后,两组患者的纤维蛋白原、白细胞均较治疗前改善,两组的变化无统计学差异(P>0.05);两组患者的血肌酐、血尿素氮均较治疗前升高,但观察组较对照组的升高程度更小(P<0.05)。治疗7 d后,观察组和对照组患者的谷丙转氨酶、谷草转氨酶、血肌酐、血尿素氮、血纤维蛋白原、白细胞均较治疗前改善(P>0.05);且观察组血肌酐、血尿素氮、白细胞的改善优于对照组(P<0.05)。两组患者的机械通气时间和ICU住院时间的中位数没有统计学差异(P>0.05)。结论:相比单纯使用肾脏替代治疗治疗重症蝰蛇咬伤患者,联合使用血液灌流治疗可以更有效地清除有毒物质,改善患者肾脏功能和控制感染。

Objective:To explore the effectiveness of continuous renal replacement therapy(CRRT)combined with hemoperfusion(HP)in critically ill patients with viper bite.Method:A total of 38 patients with severe viper bite were retrospectively reviewed for clinical data from January 2018 to January 2021,and then divided into control group and study group according to the blood purification methods.All patients were treated with conventional treatment for snakebite,the control group patients were treated with continuous veno⁃venous hemofiltration,and the study group patients were treated with continuous veno⁃venous hemofiltration combined with hemoperfusion.Hepatic function index,renal function index,coagulation index and blood routine before blood purification onset,72 hours and 7 days after blood purification were extracted for both two group patient and make comparation.The duration of mechanical ventilation and hospital stay.Results:After 72 hours of blood purification treatment,the fibrinogen and WBC in the two groups were improved compared with those before treatment,and there was no statistical difference between the two groups(P>0.05);Serum creatinine and blood urea nitrogen in the two groups were higher than before treatment,but the degree of increase in study group was less than that in control group(P<0.05).After 7 days of blood purification treatment,AST,ALT,SCr,BUN,blood fibrinogen and WBC of patients in study group and control group were improved compared with before treatment(P>0.05);The improvement of SCr,BUN and WBC in the study group was better than that in the control group(P<0.05).The median the duration of mechanical ventilation and length of ICU stay were not statistically different between the two groups(P>0.05).Conclusions:Compared with renal replacement therapy alone for severe viper bite patietns,continuous renal replacement therapy combined with hemoperfusion is more effective in the removal of toxic substances,it can significantly improve patients’renal function and infection situation.