连续性静脉-静脉血液滤过治疗重度烧伤合并急性重度高钠血症  

Effects of continuous venovenous hemofiltration on the treatment of severely burned patients with acute severe hypernatremia

作　　者：刘谊蓉 马峰[1] 周美兰[1] 于艳[1] 李洋平 孙世仁[1] 

机构地区：[1]第四军医大学西京医院肾内科,西安710033 [2]西宁市第一人民医院肾内科

出　　处：《肾脏病与透析肾移植杂志》2016年第1期35-39,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家级自然科学基金(81170670)

摘　　要：目的：探讨连续性静脉-静脉血液滤过（CVVH）治疗重度烧伤合并急性重度高钠血症的疗效观察。方法：回顾性分析2011年3月至2015年3月第四军医大学西京医院烧伤ICU 13例重度烧伤合并急性重度高钠血症行CVVH治疗的患者。置换液钠梯度是通过加入3%或10%Na Cl,使置换液的钠浓度低于血钠浓度8mmol/L,以后每4h下降2 mmol/L。结果：13例患者平均年龄49.1岁（39~57岁）,烧伤面积64.2%（44.0%~85.0%）。随访28d,死亡3例。CVVH治疗后APACHEⅡ评分[21.0（19.5~25.0）vs 24.6（22.0~28.5）,P〈0.001],脉搏[107.0次/min（93.0~120.0次/min）vs 123次/min（116~136次/min）,P=0.028）]、尿素氮[13.4mmol/L（12.1~15.5 mmol/L）vs 22.7 mmol/L（15.4~34.3 mmol/L）,P=0.018]、肌酐（167.6μmol/L（105.5~240.5）μmol/L vs 257.2μmol/L（146~399.0）μmol/L,P=0.014]和血钠[138.2 mmol/L（138.3~155.2 mmol/L）vs 166.2 mmol/L（160.9~170.5 mmol/L）,P〈0.001]较治疗前均明显改善。平均血钠纠正速率为0.62 mmol/（L·h）[0.34~0.89 mmol/（L·h）],CVVH治疗48h血钠均正常。结论：CVVH置换液钠梯度能有效治疗重症烧伤合并急性重度高钠血症。Objective： To observe the effects of continuous venovenous hemofiltration（ CVVH） on the treatment of severely burned patients with acute severe hypernatremia. Methodology： A total of thirteen severely burned patients with acute severe hypernatremia who received the CVVH treatment were admitted to our burned ICU between March 2011 and March 2015. The sodium concentration of the replacement fluid was adjusted by adding 3% or 10% sodium chloride. The sodium level of the replacement fluid was initially set to be lower than the serum sodium level by 8 mmol / L and was reduced by 2 mmol / L every 4 hours. Results： They were an average age of 49. 1 years and had an average total burn surface area of 64. 2%. 3 patients died in follow-up of 28-day. After the CVVH treatment,all patients showed a significant reduction in APACH II score（ 21. 0（ 19. 5 ~ 25. 0） vs 24. 6（ 22. 0 ~ 28. 5）,P〈0. 001） and heartbeat（ 107（ 93. 0 ~ 120） vs 123（ 116~ 136） bpm / min,P = 0. 028）. Likewise,the serum levels of urea and creatinine were decreased from 22. 7（ 15. 4 ~34. 3） to 13. 4（ 12. 1 ~ 15. 5） mmol / L（ P = 0. 018） and from 257（ 146 ~ 399） μmol / L to 168（ 106 ~ 241）（ P =0. 014）,respectively. The serum sodium reduction rate of 0. 62（ 0. 34 ~ 0. 89） mmol / L / h,all patients experienced a successful correction of hypernatremia within 48 hrs. Conclusion： Our results indicated that CVVH with gradient sodium replacement fluid was suitable for treating the acute severe hypernatremia in severely burned patients.

关 键 词：连续性静脉-静脉血液滤过 烧伤 高钠血症 血钠纠正速率 

分 类 号：R644[医药卫生—外科学] R589.4[医药卫生—临床医学]