中国血液净化

›› 2007, Vol. 6 ›› Issue (1): 29-33.

• 基础研究 • 上一篇    下一篇

持续肾脏替代治疗对创伤合并海水浸泡致急性肾衰竭犬的救治

周春华　李　 昕 李洪艳   

  1. 100037 北京，海军总医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2007-01-12 发布日期:2007-01-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2007-01-12 Published:2007-01-12

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摘要： 目的 探讨CRRT对创伤合并海水浸泡致急性肾衰竭(ARF)犬的救治效果。方法 选择海军总医院肾内科成年杂种犬30只，致腹部开放伤后在19℃～21℃的人工海水中浸泡1.5h，随机分为对照组(浸泡后不予处理)，普通救治组(浸泡后给予一般急救)和CRRT组(浸泡后一般急救加CRRT)，每组10只。检测肛温、平均动脉压、肾功能、血气分析、渗透压、电解质、TNF-α和IL-6等变化。 结果 ①对照组出现典型的海战伤伤情特点，表现为低体温，低血压，高渗，代谢性酸中毒；并且血肌酐、尿素氮、TNF-α和IL-6明显升高(P＜0.05)。②普通救治组犬的生存时间、肛温、pH、HCO3-较对照组改善(P＜0.05)，但电解质、渗透压、肾功能、TNF-α和IL-6无变化。③CRRT组犬的生存时间明显延长，各项指标的改善均优于对照组和普通救治组(P＜0.01、P＜0.05)，病理改变也是最轻的。结论 ①一般急救措施救治后，犬发生ARF的几率较对照组降低，生存时间有所延长，但大部分损伤指标无明显改善，病理提示肾脏损害严重，说明仅靠一般的急救是不够的；②经CRRT救治后，几个主要的海战伤伤情特点能够得到有效救治，总体疗效明显好于普通救治组，病理改变也非常轻，表明CRRT对于战伤合并海水浸泡导致的急性肾功能衰竭是一种非常有效的急救措施。

关键词: 急性肾衰竭, 创伤, 海水浸泡, 连续性肾脏替代疗法, 动物实验研究

Abstract: Objective To observe the different effect of early emergency treatment and continuous renal replacement therapy (CRRT) on the dog models of acute renal failure (ARF). Methods Thirty grown-up healthy dogs were randomly divided into three groups. All animals were subjected to open abdominal injury and a 1.5-hour-immersion in the 19℃～21℃ man-made seawater then immersion group won’t be treated, emergency treatment group got emergency treatment after immersion;while the CRRT group took CRRT when the dogs turned better after the emergency treatment. Anus temperature mean arterial pressure、(MAP)、mOsm、pH、BUN、Scr、electrolyte、TNF-αand IL-6 were measured. Results ①The control group presented obvious hypotension,hypothermia,hypernatremia,hyperosmolality,hyperchloremia,acid-base imbalance and ARF　and the TNF-α、IL-6 level raised up after seawater immersion(P＜0.05)；②Compared with the immersion group, The emergency treatment group’s survival time was longer and anus temperature、MAP、pH、HCO3- were improved(P＜0.05) except the electrolyte、mOsm、BUN、Scr、TNF-α and IL-6；③The CRRT group’survival time was the longest and the conditions were obviously improved than other groups(P＜0.05)，the kidney’pathologic changes of the CRRT group was the most slight of the three groups. Conclusion ①The incidence of ARF was lower after emergency treatment,and the conditions of the dogs turned better,but most dogs hyperosmolality and acid-base imbalance didn抰 improved obviously,most of their BUN、Scr、TNF-α and IL-6 still raised up obviously,and the pathologic changes still showed aggravated injury. So it抯 indicated that the emergency treatment help but is not enough. ②The dogs hypothermia, hypernatremia, hyperosmolality, hyperchloremia, acid-base imbalance, ARF,and systemic inflammatory response syndrome(SIRS) obviously got better after CRRT than the other groups,and pathologic changes was slight. It抯 proved that CRRT can improve the conditions of the ARF dogs after trauma and seawater immersion and prolong the survival time.

Key words: Wound, Seawater immersion, Continuous renal replacement, Therepy (CRRT), Animal experimentation.