中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (01): 8-11.doi: 10.3969/j.issn.1671-4091.2013.01.00

• 临床研究 • 上一篇    下一篇

连续性血液净化治疗对Ι型主动脉夹层术后横纹肌溶解伴急性肾功能衰竭患者的治疗效果观察

曹芳芳,冯雪,张海涛   

  1. 曹芳芳 100037 北京 中国医学科学院,北京协和医学院,国家心血管病中心，阜外心血管病医院，心血管疾病国家重点实验室
  • 收稿日期:2012-08-03 修回日期:2012-09-07 出版日期:2013-01-12 发布日期:2013-01-04
  • 通讯作者: 冯雪 dina07@yahoo.cn E-mail:dina07@yahoo.cn

Effects of continuous blood purification in the treatment of rhabdomyolysis combined with acute renal failure after surgery for DeBakey I aortic dissection

  • Received:2012-08-03 Revised:2012-09-07 Online:2013-01-12 Published:2013-01-04

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摘要： 【摘要】目的 研究连续性血液净化治疗（CBP）对I型主动脉夹层外科术后因下肢缺血性损伤发生横纹肌溶解伴急性肾功能衰竭患者的血流动力学影响及治疗效果。方法 入选I型主动脉夹层外科术后发生横纹肌溶解病人8例，入选标准为血清肌酸磷酸肌酶（CK）高于正常值的5倍或＞1000U/L，血肌红蛋白浓度明显升高，同时合并急性肾功能衰竭；8例患者均行连续性血液净化治疗，采用连续床旁静脉-静脉血液透析滤过(CVVHDF)模式，观察治疗前、治疗后6天、治疗后12天患者血流动力学改善情况，以及氧合指数（PaO2/FiO2）、血肌红蛋白、血CK、肌酸磷酸肌酶同工酶（CK-MB）、乳酸脱氢酶（LDH）水平的变化。结果 8例患者外科术后血CK、CK-MB、LDH、血肌红蛋白明显升高，其中4例发生明显下肢肿胀，3例行单侧下肢骨筋膜室切开，术后22±12.6h行连续性血液净化治疗，平均治疗时间15±5.2d，平均血流量235±143.9ml/h，CBP过程中1例行截肢，无患者死亡。与CBP前相比，CBP治疗后6天、12天患者氧合指数明显改善（P<0.05），血肌红蛋白、CK、CKMB、LDH明显下降（P<0.05）；治疗过程中血流动力学平稳，血管活性药物用量减少至停用，尿量明显上升。结论 连续性血液净化治疗可能通过清除炎症介质及过多的血肌红蛋白，维持水电解质和酸碱平衡，有效控制容量负荷，使主动脉夹层外科术后横纹肌溶解患者肾功能恢复，改善患者的血流动力学，从而改善了主动脉夹层患者的预后。

关键词: 连续性血液净化, 主动脉夹层, 横纹肌溶解, 肾衰竭

Abstract: 【Abstract】Objective To study the effects and hemodynamics of continuous blood purification(CBP) in treatment of rhabdomyolysis induced by lower extremity ischemic injury combined with acute renal failure after surgery for DeBakey I acute aortic disscetion. Methods 8 patients who diagnosed as rhabdomyolysis after surgery of DeBakey I aortic disscetion were enrolled.Their features were serum creatine phosphokinase(CK) increased to more than 5 times of normal or more than 1000U per liter,myohemoglobin increased significantly,and acute renal failure occurred. CBP treatment of continuous venous-venous hemodiafiltration (CVVHDF) was performed in 8 patients.Hemodynamics improvement, oxygenation index(PaO2/FiO2),serum concentration of myohemoglobin,CK,creatine phosphokinase isoenzyme-MB(CK-MB) and lactate dehydrogenase(LDH) were detected before and 6 days,12 days after the treatment. Results After surgery,CK,CK-MB,LDH and myohemoglobin of 8 patients were increased significantly,in which 4 patients had obvious leg swelling, 3 patients underwent unilateral lower limb compartment incision.CBP started after surgery 22±12.6h, the average treatment time was 15 ± 5.2days, the average blood flow was 235 ± 143.9ml per hour.During treatment,one person was amputated and no mortality. Compared with before treatment , oxygenation index improved significantly (P <0.05), myohemoglobin, CK-MB, and LDH decreased significantly (P <0.05) after 6 days and 12 days of treatment. Hemodynamics were stable during the treatment and vasoactive drugs decreased,urine output increased significantly.Conclusions CBP was effective in the treatment of rhabdomyolysis combined with acute renal failure after surgery for aortic disscetion,which might related to removal of inflammatory mediators and excessive myohemoglobin, maintain balance of water, electrolyte and acid-base,control of volume overload,amiliated hemodynamics and prognosis of patients with aortic dissection.

Key words: Continuous blood purification, Aortic dissection, Rhabdomyolysis, Renal failure