中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (12): 676-679.doi: 10.3969/j.issn.1671-4091.2013.12.00

• 临床研究 • 上一篇    下一篇

持续肾脏替代治疗在热射病合并横纹肌溶解综合征中的应用

霍苗苗1,余毅2   

  1. 1. 南京军区福州总院血液净化科
    2. 南京军区福州总医院
  • 收稿日期:2013-10-12 修回日期:2013-11-02 出版日期:2013-12-12 发布日期:2013-12-03
  • 通讯作者: 余毅yuyicn@126.com E-mail:yuyicn@126.com

Department of Hemodialysis, Fuzhou General Hospital of Nanjing Military Command, Fuzhou 350025, China; *Department of Nephrology, Fuzhou Second Hospital

  • Received:2013-10-12 Revised:2013-11-02 Online:2013-12-12 Published:2013-12-03

RichHTML

0

PDF

410

摘要： 【摘要】目的 探讨热射病(HS)合并横纹肌溶解综合征(RM)患者辅助应用持续肾脏替代治疗(CRRT)的临床效果。方法 回顾性分析HS合并RM的资料6例，采用综合治疗和CRRT辅助治疗，观察其临床疗效和转归。结果 6例患者中5例痊愈出院，1例死亡。治愈的5例，与CRRT治疗前比较，CRRT治疗后患者血流动力学保持稳定，体温、心率、平均动脉压均有明显改善；APACHEⅡ评分降低(P<0.05)，Glasgow昏迷量表(GCS)评分升高（P<0.05）；血肌酐、肌酸磷酸激酶、肌红蛋白、乳酸脱氢酶、谷草转氨酶、谷丙转氨酶、C反应蛋白和钾离子水平显著降低(P<0.05），直至正常。结论 CRRT是抢救HS合并RM患者有效手段之一，可能对HS合并RM有改善预后的作用。

关键词: 持续肾脏替代治疗, 热射病, 横纹肌溶解综合征

Abstract: 【Abstract】 Objective To investigate the effect of continuous renal replacement therapy (CRRT) on heat stroke (HS) patients complicated with rhabdomyolysis (RM). Methods Six patients with severe heat stroke and RM were treated with CRRT combined to other comprehensive measures. Their therapeutic effects and prognosis were evaluated. Results After the treatment, 5 of the 6 patients recovered and discharged from the hospital and one patient died. In the 5 recovered patients, vital signs improved significantly after CRRT therapy for 24h, 48h, and 7 days as compared with the clinical conditions before CRRT; heart rate (F=19.987, P=0.000), body temperature (F=52.979, P=0.000), and APACHE II scores (F=64.904, P=0.000) decreased; the Glasgow coma score (GCS) (F=28.818, P=0.000) and mean arterial blood pressure (F=5.391, P=0.009) increased; serum myoglobin (F=55.605, P=0.000), phosphokinase (F=64.904, P=0.000), alanine aminotransferase (F=8.503, P=0.001), aspartate aminotransferase (F=8.166, P=0.002), creatinine (F=9.296, P=0.001), lactate dehydrogenase (F=91.839, P=0.000), C-reactive protein (F=10.852, P=0.000), serum potassium (F=23.678, P=0.000) concentrations decreased. Conclusions CRRT is one of the effective approaches for emergent treatment of HS patients complicated with RM. CRRT can be well tolerated and can improve the prognosis of HS patients complicated with RM.

Key words: Renal replacement therapy, Heat stroke, Rhabdomyolysis