早期血液净化治疗苯酚烧伤并发急性肾损伤的临床观察  

Clinical observation on the treatment of phenol burn patients complicated by acute kidney injury with early blood purification

作　　者：冯世海[1] 刘群[1] 马伟[1] 贾享成 谢宇钢 

机构地区：[1]天津市第四医院烧伤整形科,300222

出　　处：《中华烧伤杂志》2015年第6期416-420,共5页Chinese Journal of Burns

摘　　要：目的观察早期血液净化治疗苯酚烧伤并发急性肾损伤（AKI）的临床效果。方法2010年1月-2014年7月，笔者单位收治符合入选标准的5例苯酚烧伤并发AKI患者。伤后24h内，快速补液扩容；积极处理创面；采用血液灌流（HP）联合连续性静脉一静脉血液滤过疗法（CVVH）治疗2～3h，停用HP，持续CVVH治疗16—21h。HP4-CVVH治疗2、3次后停用HP，继续行CVVH治疗12～22d。伤后1、3、5、7、14、21d，抽取患者静脉血，检测尿素氮、肌酐、ALT、AST、总胆红素（TBIL）、直接胆红素（DBIL）；记录液体总人量、尿量、超滤量、液体总出量；ELISA法测定血清IL-6、IL-10、TNF—α浓度。记录患者一般情况。对数据行单因素方差分析、LSD．t检验。结果（1）伤后1d，患者尿素氮、肌酐分别为（9．0±3．2）mmol／L、（115±24）μmol／L，较正常值（分别为2．9～8．2mmol／L、45～104μmol／L）明显升高。伤后3、5、7、21d，患者尿素氮分别为（12．5±4．1）、（11．2±5．6）、（8．7±2．3）、（6．4±3．9）mmol／L，与伤后1d接近（t值分别为1．53、0．76、0．17、1．17，P值均大于0．05）；伤后14d，患者尿素氮为（15．8±3．3）mmol／L，明显高于伤后1d（t=3．29，P=0．023）。伤后3、5、7、14d，患者肌酐分别为（248±67）、（224±87）、（276±59）、（307±77）μmol／L，明显高于伤后ld（t值分别为4．17、2．70、5．65、5．32，P值均小于0．01）；伤后21d，患者肌酐为（78±28）μmol／L，明显低于伤后1d（t=2．23，P=0．041）。患者ALT、AST、TBIL、DBIL伤后1d开始较正常值升高，伤后3、5、7、14d均高于正常值，伤后21d与正常值接近。（2）伤后1、3、5、7、14、21d，患者能够保持液体总人量与液体总出量比为1：1～2：1；伤后1、3、5、7、14d，患者尿量虽有波动，但仍小于400mL／d，超滤量呈现先降低后升高趋势；伤后21d，患者�Objective To observe the clinical effects of early blood purification in the treatment of phenol burn patients complicated by acute kidney injury （AKI）. Methods Five phenol burn patients complicated by AKI, matched with the inclusion criteria, were hospitalized from January 2010 to July 2014. Within post injury hour 24, patients received rapid liquid support, positive wound management, and he- moperfusion （HP） combined with continuous veno-venous hemofihration （CVVH） for 2 to 3 hours, then HP was stopped and CVVH was continued for 16 to 21 hours. HP combined with CVVH was performed for 2 to 3 times, then HP was stopped and CVVH was continued for 12 to 22 days. On post injury day （PID） 1 , 3, 5, 7, 14, and 21, urea nitrogen, creatinine, ALT, AST, total bilirubin （TBIL）, direct bilirubin （DBIL） in serum were determined, and the volume of liquid intake, urine, ultrafihration, and liquid output were recorded, and the concentrations of IL-6, IL-10 and TNF-α in serum were determined by ELISA. General con-ditions of patients were recorded. Data were processed with one-way analysis of variance and LSD- t test. Results （1） On PID 1, the levels of urea nitrogen and creatinine were （9.0±3.2） mmol/L and （115 ± 24） μmol/L respectively, which were obviously higher than normal values （with the values of 2. 9 - 8.2 mmol/L and 45 - 104 μmol/L respectively）. On PID 3, 5, 7 and 21 , the levels of urea nitrogen were （12.5 ±4.1）, （11.2 ±5.6）, （8.7 ±2.3） and （6.4 ±3.9） mmol/L respectively, which were similar with the value of DID 1 （ with t values 1.53, 0. 76, 0.17 and 1.17 respectively, P values above 0.05 ）. On PID 14, the level of urea nitrogen was （ 15.8 ± 3.3） mmol/L, which was obviously higher than the value of PID 1 （ t =3.29,P =0.023）. OnPID3, 5,7 and 14, the levels of creatinine were （248 ±67）, （22± 87 ） , （ 276 ± 59） and （ 307 ± 77 ） μmol/L respectively, which were obviously higher than the value of PID 1 （with t values 4.17,

关 键 词：烧伤 化学 血液滤过 血液灌注 苯酚 急性肾损伤 

分 类 号：R644[医药卫生—外科学] R692.5[医药卫生—临床医学]