烧伤并发少尿型急性肾功能衰竭43例临床分析

目的:探讨烧伤并发少尿型急性肾功能衰竭(Acute Renal Failure ARF)的防治方法。方法:对近20年收治的43例烧伤并发ARF病例资料,总结分析其发病特点和治疗结果。结果:本组发病年龄1.5-87岁,均为重度和特重度烧伤,于48 h内7 d内确诊者分别占48.8％和81.45％,2 h后开始接受液体复苏者,ARF发病率明显高于2 h内者,合并休克、色素尿、吸入性损伤和脓毒症(sepsis)者分别占72.1％、67.4％、51.2％和37.2％。死亡42例,死亡率97.7％。12例接受透析治疗,1例为腹膜透析,11例行血液透析,治愈1例采用连续性肾替代治疗(CRRT),11例透析死亡病例平均存活8.7 d,明显长于其余31例未透析全部死亡者的4.3 d(P<0.05)。结论:少尿型ARF多发生于严重烧伤早期(1周内),伤情越重,入院时间越晚,发病率越高;合并休克、色素尿、吸入性损伤和脓毒症是诱发ARF的高危险因素。透析治疗虽未能明显提高存活率,但可延长生存时间,为去除ARF原发病因如切痂植皮创造机遇,CRRT因对血流动力学干扰小,能平稳清除毒素和内毒素,可能是治疗烧伤并发ARF较有前景的手段之一。

The clinical analysis of 43 cases burned accompanied by oliguria acute renal failure

Objective: To investigate the prophylactic measures for oliguria acute renal failure with burned patients. Methods : To sum up and analyse the 43 patients burned accompanied by acute renal failure and admitted in our hospital recently 20 years coming on characteristics and treated outcome. Results: The cases ' age distributed in 1.5 to 87 years old, their injuried condition were in severe and more severe degree burned, the 21 cases (48.8%) were made a definite diagnosis in 48 hours and 35 cases (81.4%) in7 days.The morbidity in the cases beginning to accepted liquid resuscitation after 2 hours post burned is more high than in 2 hours. In the 43 cases, there were 31 cases (72.1%),29 cases (67.4%),22 cases (51.2%) and 16cases (37.2%) to complicate with shock, chromaturia,inhalation injury and sepsis,and 42 cases (97.7% ) were death.The 12 cases were accepted dialysis, 1 case was peritoneal dialysis, 11 cases were hemodialysis, 1 case was cured with continue renal recepted therapy ( CRRT) . 11 cases accepted dialysis were death and their average living time was 8.7 days, the time was more longth than 4.3 days of the 31 death patients nor-accepted the treatment( P < 0.05) . Conclusion : Acute renal failure (ARF) with oliguria usually occurs in the early stage of severe burned (in 1 week ) , these cases who admitted in hospital later and seriously injury are more incidence of ARF.To accompanied by shock and chromaturia and inhalation injury and sepsis are the high dangerous factors to occour ARF. Dialysis does not rise notablely their living rate, but it could prolong living term and set up a favourable to remove primary affection such as excising grafting. Continue renal recepted therapy ( CRRT) may be a good method to treat ARF, because it effects seldom hemodynamics and can clear calmly toxinum and endotoxin.