血浆置换联合连续性肾脏替代疗法在劳力性热射病患者中的临床应用效果分析

Clinical Effectiveness of Plasma Exchange Combined with Continuous Renal Replacement Therapy in Exertional Heat Stroke Patients

目的探索对于劳力性热射病患者采取血浆置换联合连续性肾脏替代疗法的治疗效果。方法收集2020年7月至2023年9月在莆田九十五医院急救医学科就诊的80例劳力性热射病患者临床资料,根据急救方法的不同分为观察组与对照组,观察组采用血浆置换联合连续性肾脏替代疗法,对照组采用连续血液透析,每组各40例。比较两组患者的生化指标、主要生命体征、急性病生理学和长期健康评价(Acute Physiology and Chronic Health Evaluation,APACHE)评分以及救治成功率。结果治疗前,两组患者丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBL)、血清肌酐(Cr)、血清肌酸激酶(CK)、D-二聚体(D-dimer)水平,T/℃、心率、氧合指数、APACHE评分均无显著差异(P>0.05)。治疗后,两组患者ALT、AST、TBL、Cr、CK、D-dimer水平均显著降低(P<0.001),且和对照组相比,观察组患者降低水平更显著;两组患者T/℃、心率、APACHE评分也均显著降低,氧合指数显著升高(P<0.001),且和对照组相比,观察组患者T/℃、心率、APACHE评分降低更显著,氧合指数升高更显著。观察组患者抢救成功率为95.00%,显著高于对照组的75.00%,差异有统计学意义(P<0.05)。结论劳力性热射病患者采取血浆置换联合连续性肾脏替代疗法,可显著改善患者血清生化指标和主要生命体征,降低患者APACHE评分,提高抢救成功率。

Objective To explore the therapeutic effect of plasma exchange combined with continuous renal replacement therapy for patients with exertional heatstroke.Methods Clinical data of 80 patients with exertional heatstroke who visited the Emergency Medicine Department of Putian Hospital,Fujian Province from July 2020 to September 2023 were collected.The patients were divided into the plasma exchange combined with continuous renal replacement therapy group(observation group)and the continuous hemodialysis group(control group),with 40 cases in each group.The biochemical indicators,main vital signs,APACHE score,and treatment success rate of the two groups were compared.Results Before treatment,there were no significant differences in ALT,AST,TBL,Cr,CK,D-Dimer levels,T/°C,heart rate,oxygenation index,and APACHE score between the two groups(P>0.05).After treatment,the levels of ALT,AST,TBL,Cr,CK,and D-Dimer in both groups were significantly reduced(P<0.001),and the reduction was more significant in the observation group compared to the control group.The T/°C,heart rate,and APACHE score of both groups were significantly reduced,and the oxygenation index was significantly increased(P<0.001).Compared to the control group,the observation group showed more significant reductions in T/°C,heart rate,and APACHE score,and more significant increase in the oxygenation index.The rescue success rate of the observation group was 95.00%,significantly higher than the rescue success rate of the control group(75%)(P<0.05).Conclusion Plasma exchange combined with continuous renal replacement therapy for patients with exertional heatstroke can significantly improve the patients'serum biochemical indicators and main vital signs,reduce the patients'APACHE score,and increase the rescue success rate.