早期持续肾脏替代治疗热射病临床疗效分析

摘要

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 Gen-eral 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,creati-nine,myoglobin,creatine kinase,alanine aminotransferase,aspartate aminotransferase and arterial lactic acid with take sam-ples 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) ,APACHEⅡscore and oxygenation index( PaO2/FiO2 ) were signifi-cantly improved compared with those before treatment(P<0. 05). Serum urea nitrogen,creatinine,myoglobin,creatine ki-nase,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 ef-fectively reduce the body temperature, remove myoglobin,creatinine and remove inflammatory cytokines and support func-tion of important organs such as liver and kidney. CRRT is safe and effective in the treatment of patients with heat stroke.%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,CV-VH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。