持续肾脏替代治疗在热射病合并横纹肌溶解综合征中的应用  

Application of continuous renal replacement therapy on heat stroke patients complicated with rhabdomyolysis

作　　者：霍苗苗[1,2] 余毅[1] 王琰[1] 孙淑清[1] 林曰勇[1] 陈今[1] 

机构地区：[1]南京军区福州总医院血液净化科,福建350025 [2]福州市第二医院肾内科,福建350025

出　　处：《中国血液净化》2013年第12期676-679,共4页Chinese Journal of Blood Purification

摘　　要：目的探讨热射病(heat stroke,HS)合并横纹肌溶解综合征(rhabdomyolysis,RM)患者辅助应用持续肾脏替代治疗(continuous renal replacement therapy,CRRT)的临床效果。方法回顾性分析HS合并RM的资料6例,采用综合治疗和CRRT辅助治疗,观察其临床疗效和转归。结果 6例患者中5例痊愈出院,1例死亡。治愈的5例,与CRRT治疗前比较,CRRT治疗后24h、48h、7d不同的时间点,患者生命体征均明显改善,包括:体温降低(F=52.979,P=0.000)、心率减慢(F=19.987,P=0.000)、平均动脉压升高(F=5.391,P=0.009);APACHEⅡ评分降低(F=64.904,P=0.000),Glasgow昏迷量表(GCS)评分升高(F=28.818,P=0.000)。生物化学指标显著改善,包括:血肌酐降低(F=9.296,P=0.001)、肌酸磷酸激酶降低(F=64.904,P=0.000)、肌红蛋白降低(F=55.605,P=0.000)、乳酸脱氢酶降低(F=91.839,P=0.000)、谷草转氨酶降低(F=8.166,P=0.002)、谷丙转氨酶降低(F=8.503,P=0.001)、C反应蛋白降低(F=10.852,P=0.000)和钾离子降低(F=23.678,P=0.000)。结论 CRRT是抢救HS合并RM患者有效手段之一,可能对HS合并RM有改善预后的作用。Objective To investigate the effect of continuous renal replacement therapy （CRRT） on heat stroke （HS） patients complicated with rhabdomyolysis （RM）.Methods Six patients with severe heat stroke and RM were treated with CRRT combined to other comprehensive measures.Their therapeutic effects and prognosis were evaluated.Results After the treatment,5 of the 6 patients recovered and discharged from the hospital and one patient died.In the 5 recovered patients,vital signs improved significantly after CRRT therapy for 24h,48h,and 7 days as compared with the clinical conditions before CRRT; heart rate （F=19.987,P=0.000）,body temperature （F=52.979,P=0.000）,and APACHE Ⅱ scores （F=64.904,P=0.000） decreased; the Glasgow coma score （GCS） （F=28.818,P=0.000） and mean arterial blood pressure （F=5.391,P=0.009） increased; serum myoglobin （F=55.605,P=0.000）,phosphokinase （F=64.904,P=0.000）,alanine aminotransferase （F=8.503,P=0.001）,aspartate aminotransferase （F=8.166,PP=0.002）,creatinine （F=9.296,P=0.001）,lactate dehydrogenase （F=91.839,P=0.000）,C-reactive protein （F=10.852,P=0.000）,serum potassium （F=23678,P=0.000） concentrations decreased.Conclusions CRRT is one of the effective approaches for emergent treatment of HS patients complicated with RM.CRRT can be well tolerated and can improve the prognosis of HS patients complicated with RM.

关 键 词：持续肾脏替代治疗 热射病 横纹肌溶解综合征 

分 类 号：R459.5[医药卫生—治疗学]