烧伤休克期小儿急性肾损伤的防治  

Prevention and treatment acute kidney injury in the children during burn shock stage

作　　者：周锐华[1] 鄢文海[2] 

机构地区：[1]濮阳市油田总医院烧伤整形科,457001 [2]郑州大学基础医学院病理生理教研室,450052

出　　处：《中华损伤与修复杂志（电子版）》2013年第5期35-39,共5页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

摘　　要：目的探讨烧伤休克期补液对小儿急性肾损伤(AKI)的影响及联合检测血清肌酐(SCr)、胱抑素C(CysC)、尿微球蛋白及尿酶的临床应用。方法回顾性分析2010年6月至2013年6月濮阳市油田总医院烧伤整形科收治的严重烧伤患儿116例的病例资料,随机分为传统组(采用传统方案治疗)和改进组(采用改进后方案治疗)进行补液治疗,其中传统组59例,改进组57例。有休克症状的经液体复苏达休克治疗终点指标。烧伤早期1、3、5 d进行SCr、血尿素氮(BUN)、CysC、肾小球滤过率(GFR)及尿a1微球蛋白(a1-MG)、β2微球蛋白(β2-MG)、N-乙酰-B-D-氨基葡萄糖苷酶(NAG)检测,同时依据急性肾损伤网络(AKIN)关于AKI的分级诊断标准(基于RIFLE)评估,所获数据进行样本率、样本均数比较,采用u检验。分析两组液体治疗对AKI的影响程度。结果补液治疗第1个24 h实际补液总量占公式计算量:59例传统组患儿(108.5±9.3)%,57例改进组患儿(141.7±28.2)%。第2个24 h实际补液总量占公式计算量:59例传统组患儿(104.6±10.3)%,15例休克期度过不平稳。57例改进组患儿(103.8±9.4)%,7例休克期度过不平稳。发生急性肾损伤:传统组17例(28.8%),改进组7例(12.3%),AKI发生率比较差异具有统计学意义(aP<0.05)。传统组与改进组液体治疗后CysC第1、3天比较差异具有高度统计学意义(P<0.01)。a1-MG、β2-MG、NAG第1、3、5天比较差异均具有高度统计学意义(P<0.01)。结论小儿严重烧伤后及时、快速、充分的液体治疗,尽快纠正休克,可以降低AKI的发生率。动态检测CysC、尿微球蛋白及尿酶准确评估AKI,监测肾小球、肾小管功能,能安全实施个体化补液及综合治疗。Objective To investigate the effects of fluid resuscitation for shock on children acute kidney injury and combined detection of serum creatinine,serum cystatin C,urine microglobulin and urinary enzymes in clinical application. Methods 116 cases of severely burned children admitted to the department of burns and plastic surgery in puyang city oil field general hospital from June 2010 through June 2013 were included in this study,randomLy divided into traditional therapy group and improvement therapy group, traditional group 59 cases,57 cases improved group. Shock symptoms after fluid resuscitation of shock treatment endpoints. Early 1,3,5 days of Serum creatinine（ SCr）,Blood urea nitrogen（ BUN）,Cystatin C（ CysC）,Glomerular filtration rate（ GFR） and a 1 urine microglobulin（ a1-MG）,β 2 microglobulin（ β 2 MG）,N-acetyl-B-D-Glucosaminidase（ NAG） were detected,at the same time the patients were assessed on the basis of the acute kidney injury newwork（ AKIN） acute kidney injury（ AKI） on the classification standard（ based on RIFLE）. Data obtained are compared,and sample rate,sample mean by u test. Two groups of liquid treatment to analyze the influence degree of the acute kidney injury. Results Fluid therapy in first 24 h practical formula to calculate the amount of total fluid volume： 59 cases of children with traditional group（ 108. 5 ± 9. 3） %,57 cases improved group were（ 141. 7 ± 28. 2） %. Second 24 h actual fluid total formula calculation： 59 cases of children with traditional group（ 104. 6 ± 10. 3） %,15 cases through burn shock stage is not smooth. 57 cases improved group were（ 103. 8 ± 9. 4） %,7 cases of shock stage is not smooth. Acute kidney injury： a traditional set of 17 cases（ 28. 8%）,7 cases（ 12. 3%） improved group. Statistically significant differences in sample rate（aP〈0. 05）. Traditional group and improvement group liquid CysC 1,3 days after treatment had highly statistically significant difference were observed in the compa

关 键 词：烧伤 儿童 补液疗法 急性肾损伤 胱抑素C 尿微量蛋白 酶 

分 类 号：R726.9[医药卫生—儿科]