严重电烧伤患者术后早期行CRRT的临床研究  

Clinic study of early postoperative application of CRRT in severely electric burned patients

作　　者：刘维[1] 许钊荣[1] 陈昭宏[1] 

机构地区：[1]福建医科大学附属协和医院烧伤科,福建福州350001

出　　处：《中国急救医学》2017年第3期226-229,共4页Chinese Journal of Critical Care Medicine

基　　金：国家临床重点专科建设项目经费资助;福建省临床重点专科建设项目资助

摘　　要：目的探讨严重电烧伤患者术后早期行连续性’肾替代治疗（continuous renal replacement therapy，CRRT）对炎症因子水平及患者预后的影响。方法将严重电烧伤患者43例，随机分成常规组及CRRT组；常规组按常规治疗，CRRT组在术后24h内行CRRT治疗，用连续性静脉-静脉血液滤过（CVVH）模式，采集两组术前及术后1h和72h肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）及血清肌红蛋白水平，总结并评估两组患者并发症及治疗效果。结果两组患者伤后急性肾功能不全发生情况比较差异无统计学意义（X2=0．616，P=0．4325〉0．05），两组患者术前IL-1β、TNF-α及血清肌红蛋白水平较正常值明显升高，术后1h两组IL-1β、TNF-α水平较术前上升，术后72h两组IL-1β、TNF-α水平下降，CRRT组较常规组下降趋势更明显，两组比较差异有统计学意义（t值分别为15．916、9．522，P〈0．05）；两组术后72h血清肌红蛋白水平比较差异有统计学意义（t=9．208，P〈0．05），两组治疗后脓毒症及多器官功能障碍综合征（MODS）发生率比较差异有统计学意义（脓毒症：x2=6．776，P=0．0209〈0．05；MODS：X2=6．435，P=0．011〈0．05），病死率比较差异无统计学意义（x2=0．410，P=0．522〉0．05）。结论CRRT可有效清除严重电烧伤患者炎症因子及毒素水平，改善全身炎症反应，减少发生脓毒症及MODS风险，但对改善病死率无统计学意义。Objective To investigate early postoperative application of continuous renal replacement therapy （CRRT） contributing to severely electric burned patients. Methods The clinical characteristics of forty-three patients with severely electric burn were collected and randomly divided into traditional group and CRRT group, twenty-two patients acquire postoperative CRRT and twenty-two patients in traditional therapy. The inflammatory cytokines IL- 1β, TNF-α and myoglobin in serum of the patients in both groups were detected in preoperative and postoperative （1 h and 72 h after operation） time. Complications and results of two methods were analyzed retrospectively. Results Two groups had no differences in occurrence rate of acute renal failure （X2 = 0.616, P = 0.4325 〉 0.05）. IL- 1β, TNF-α normally increased in both groups and rose a lot more after operation （1 h） , while decreased within 72 h after operation. IL-1β and TNF-α in CRRT group dropped a lot more compared with traditional group （t = 15.916, 9.522, P〈 0.05）. Myoglobin in both groups came down after burn by degrees, and CRRT group decreased more compared with traditional group （t = 9.208, P〈 0.05）; there were differences in the occurrence of sepsis and MODS （sepsis X2 = 6.776, P = 0.0209 〈 0.05; MODS X2 = 6.435, P = 0.011 〈 0.05）, and no difference in mortality of both groups. Conclusion CRRT can relieve the symptom of inflammatory and risk of MODS by cleaning up inflammatory factors and toxin effectively, yet have no differences in mortality.

关 键 词：电烧伤 连续性.肾替代治疗(CRRT) 炎症因子 肌红蛋白 脓毒症 

分 类 号：R644[医药卫生—外科学]