Effects of continuous venous-venous hemofiltration on heat stroke patients: a retrospective study.

摘要

BACKGROUND: Heat stroke (HS) is a fatal illness characterized by an elevated core body temperature above 40 degrees C and complicated with rhabdomyolysis and acute renal failure. We retrospectively analyzed the effect of continuous veno-venous hemofiltration (CVVH) in patients with HS. METHODS: A total of 16 patients with HS were retrospectively analyzed. All patients were treated by CVVH for at least 96 hours, and CVVH was initiated with replacement fluid between 25 degrees C and 30 degrees C for 2 hours to 2.5 hours, and 36 degrees C thereafter. The vital signs were monitored and blood samples were collected during CVVH to measure serum urea, creatinine, myoglobin, creatine kinase, and total bilirubin. RESULTS: All patients survived. The core temperature of the patients decreased from 41.3 +/- 0.2 degrees C to 38.7 +/- 0.1 degrees C after 2 hours and to 36.7 +/- 0.1 degrees C after 5 hours during CVVH (p < 0.05). Compared with values before starting CVVH, there were remarkable improvements in mean arterial blood pressure, heart rate, and oxygenation index (p < 0.05). The serum creatinine, urea, myoglobin, and creatine kinase decreased significantly (p < 0.05), while the bilirubinemia had no obvious decline (p > 0.05). The scores of APACHE II and arterial lactate had also obvious decline (p < 0.05). The hemodynamic variables were stabilized during CVVH, and no obvious side effects related to CVVH were found. CONCLUSIONS: CVVH is safe and feasible in the treatment of patients with HS by lowering core temperature, removal of myoglobin, support of multiorgan function, and modulating systemic inflammatory response syndrome (SIRS). The impact of CVVH on patient outcome, however, still needs proof by larger randomized controlled trials.