连续性肾脏替代治疗对危重烧冲伤患者肺功能的影响  

Continuous Renal Replacement Therapy on lung Function in Patients with Severe burn-blast Injury

作　　者：吕苏一[1] 孟建中[1] 于颖[1] 葛彦明[1] 景颖[1] 贾凤玉[1] 王素霞[1] 刘文渊[1] 岳冀[1] 

机构地区：[1]济南军区总医院血液净化科,济南250031

出　　处：《生物医学工程研究》2011年第2期124-127,共4页Journal Of Biomedical Engineering Research

摘　　要：探讨连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)对19例烧冲伤患者肺功能的影响。在常规补液抗休克、预防性气管切开、抗感染等抢救治疗基础上,根据病情采用CRRT治疗8～28h,连续5～7d,观察治疗前后生命体征、动脉血氧分压、动脉血氧饱和度、胸片及血清内皮素(ET)、血管性假血友病因子(von Willebr and Factorv,WF)、血乳酸(lac)浓度的变化。结果表明:(1)CRRT治疗后患者心率、呼吸次数降低,动脉血氧分压(PaO2)、动脉血氧饱和度(SaO2)明显上升(,P<0.05);而血ET、vWFl、ac浓度、肺循环阻力指数(PVRI)与ALI评分值则同步下降(,P<0.05)。(2)治疗终点:12例(63.17%)患者在实施CRRT的同时成功完成切痂、取皮、植皮手术,最终于伤后39～65 d创面闭合,痊愈出院。5例并发AKI患者经120 h治疗后,脱离少尿期。死亡7例(36.84%),死亡原因为弥漫性血管内凝血(DIC)、脓毒症、多脏器功能衰竭(MODS)。(1)烧冲伤时,受损的内皮细胞(VEC)通过启动"免疫、凝血"双反应瀑布,释放大量ET、vWF入血,促使肺血管收缩,活化血小板,加重肺组织缺血缺氧,参与了ARDS、DIC、脓毒症、MODS的进展过程。(2)采用CRRT能有效清除ET v、WF等炎症介质,减轻肺间质水肿,改善组织摄氧能力,增加氧合指数,降低肺循环阻力指数及ALI评分值。(3)CRRT可为烧冲伤患者的植皮手术创造条件,并为缩短病程,降低病死率争取时间。To observe the effect of continuous renal replacement therapy on 19 ca ses of burn-blast injury in patients with pulmonary function.In the base of life-saving treatments that conventional fluid anti-shock,preventive trach eotomy,anti-infection,based on the condition of patients,they were treated wit h CRRT 8～28 h,continuous 5～7 d,The changes of vital signs,blood pressure,arterial oxygen saturation,chest radiograph and serum endothelin（ET）,von Wi llebrand factor（von Willebr and Factor,vWF） and blood lactate（lac） concentrat ion before and after treatment were investigated.Result showed that（1）After tr eatment with CRRT,heart rate,respiratory rate decrease,blood pressure,arteri al oxygen saturation of burn-blast injury patients increased significantly;howe ver,serum ET,vWF,lac concentration,pulmonary vascular resistance index and t he value of the synchronization ALI score decreased.（2）12 patients in the impl ementation of CRRT were successful accepted escharectomy,skin taking,skin graft ing,and 39～65 d after injury,the wound closed,then discharged.After 120 h a fter treatment,5 cases with AKI were out of from oliguria.7 cases were died of disseminated intravascular coagulation,sepsis,multiple organ failure.It proves that：（1）Burn-blast injury,the damaged endothelial cells can start ＂th e immune,coagulation＂,the release of a large number of ET,vWF into blood,ca n contribute to pulmonary vasoconstriction,and further activate platelets and endothelial adhesion,thereby increasing the lung tissue ischemia and hypoxia,i n the ARDS,DIC,sepsis,MODS in the progression.（2）CRRT can remove ET,vWF and other inflammatory mediators,thereby reducing pulmonary interstitial edema,imp rove tissue oxygen uptake capacity,increasing oxygenation index, decrease pulmonary vascular resistance index and ALI score values.（3）Use of CRR T for the treatment of patients with burn-blast injury to create conditions for skin grafting,and can shorten the course of the disease,reduce mortality.

关 键 词：烧冲复合伤 肺损伤 连续性肾脏替代治疗 血管性假血友病因子 植皮 手术 

分 类 号：R318[医药卫生—生物医学工程]