连续性肾替代疗法对劳力性热射病致急性肾损伤疗效及其对血清肿瘤坏死因子α、白细胞介素6水平影响  

Efficacy analysis for continuous renal replacement therapy in treatment of exertional heatstroke induced acute kidney injury and its influence on the serum tumor necrosis factor-α,interleukin-6

作　　者：李志伟 孟强[1] 王玲[2] 高燕 LI Zhi-wei;MENG Qiang;WANG Ling;GAO Yan(Department of Emergency,Armed Police Corps Hospital of Liaoning Province,Shengyang 110034,China)

机构地区：[1]武警辽宁省总队医院急诊医学科,辽宁沈阳110034 [2]北部战区总医院急诊医学部,辽宁沈阳110016

出　　处：《创伤与急危重病医学》2022年第2期88-91,共4页Trauma and Critical Care Medicine

基　　金：重症多发伤重要脏器功能保护研究(CSY12J002)。

摘　　要：目的探讨连续性肾替代疗法(CRRT)对劳力性热射病(EHS)致急性肾损伤(AKI)患者的临床疗效及其对肿瘤坏死因子(TNF-α),白细胞介素6(IL-6)水平的影响。方法选取自2016年6月至2021年6月救治的42例EHS致AKI患者为研究对象。所有EHS致AKI患者均需CRRT治疗,根据改善全球肾脏病预后组织(KDIGO)临床实践指南AKI分期标准将患者分为A组(n=22)与B组(n=20)。A组患者开始行CRRT治疗时机为AKI-3期,B组患者开始行CRRT治疗时机为AKI-2期。两组患者均给予持续有效降温、积极扩容补液、镇静、机械通气、抗凝、抗感染、纠正酸碱失衡及脏器功能支持等常规治疗。应用急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)评估两组患者的临床疗效,监测治疗12 h后体温控制水平,尿量开始恢复时间,入住EICU治疗时间。比较两组患者治疗3 d后肾功能指标尿素氮(BUN)、肌酐(Scr)、血尿酸(UA)及血清TNF-α、IL-6水平的差异。结果治疗后,B组患者APACHEⅡ评分下降幅度、治疗12 h后体温控制水平均优于A组,尿量开始恢复时间及入住EICU治疗时间均短于A组,差异均有统计学意义(P<0.05)。治疗3 d,两组患者后肾功能指标BUN、Scr、UA均较治疗前改善,且B组患者的改善程度明显优于A组,差异有统计学意义(P<0.05)。治疗3 d,两组患者的炎性因子指标TNF-α、IL-6较治疗前下降,且B组患者的下降幅度明显高于A组患者,差异有统计学意义(P<0.05)。结论CRRT治疗EHS所致的AKI疗效确切,能及时清除血浆中的溶质分子和炎性介质。同时,按照KDIGO临床实践指南AKI分期前移CRRT治疗时机,可显著改善EHS致AKI患者的肾功能,降低血清炎性因子水平。Objective To study the clinical effect for continuous renal replacement therapy(CRRT)in treatment of exertional heatstroke(EHS)induced acute kidney injury(AKI)and its influence on the serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6).Methods A total of 42 with EHS induced AKI who were admitted from June 2016 to June 2021.all the patients with EHS induced AKI need CRRT treatment,and the patients were divided into Group A(n=22)and Group B(n=20)according to the clinical practice guidelines AKI stage of Kidney Disease:Improving Global Outcomes(KDIGO).The time begin to treat with CRRT in Group A was AKI-3 stage,and the time begin to treat with CRRT in Group B was AKI-2 stage.Patients in the two groups were given regular treatment with continous effective cooling,actively expand capacity and replenish fluid,sedation,mechanical ventilation,anticoagulation,anti-infection,adjusting acid-base imbalance,organ function support.The clinical effect of the patients in two groups was evaluated by acute physiology and chronic health evaluationⅡ(APACHEⅡ),monitor the temperature control level after 12 hours treatment,urine volume recovery time,treatment time in EICU of the patients in the two groups.Renal function index of blood urine nitrogen(BUN),serum creatinine(Scr),Uric acid(UA)and the level of TNF-α,IL-6 were compared between the two groups after 3 days of treatment.Results The decrease of APACHEⅡ,temperature control level at 12 hours after treatment in Group B were better than that in Group A,and the recovery time of urine volume and hospitalization time in EICU were shorter than that in Group A,with statistical significance(P<0.05).After 3 days of treatment,BUN,Scr and UA of renal function indexes in two groups were improved compared with before treatment,and the improvement degree of Group B was significantly better than Group A,the difference was statistically significant(P<0.05).After 3 days of treatment,the inflammatory factors TNF-αand IL-6 in two groups were decreased compared with before treatment,an

关 键 词：连续性肾替代疗法 劳力性热射病 急性肾损伤 

分 类 号：R594.1[医药卫生—内科学]