持续肾脏替代治疗在合并多脏器功能不全综合征的热射病患者中的应用价值

【目的】探讨持续肾脏替代治疗（continuousrenalreplacementtherapy，CRRT）在合并多脏器功能不全综合征（multipleorgandysfnnctionsyndrome，MODS）的热射病（heatstroke，HS）患者中的应用效果。【方法】对2010年7月15日一2010年8月30日在我院应用CRRT治疗合并MODS的19例热射病患者的临床资料进行回顾性分析。所有患者采用CVVH方法，CVVH置换液初始温度为28（2～32℃持续2—2．5h，之后置换液维持36℃。监测生命体征，在CVVH治疗前及治疗后采集血样，检测血清尿素氮（BUN）、肌酐（cr）、肌红蛋白（Mb）、肌酸激酶（CK）、谷丙转氨酶（GPT）、谷草转氨酶（SGOT）及动脉乳酸（Lac）。【结果】15例痊愈或好转，4例死亡。经CRRT治疗患者的核心温度由（41．6±0．3）℃下降至（36．8±0．2）℃（P〈0．05）。患者的平均动脉血压（MAP）、心率（HR）、APACHEll评分、氧合指数（PO2／FIO2）与CVVH治疗前相比有明显的改善（P〈0．05）。血清肌酐、尿素、肌红蛋门、肌酸激酶、谷丙转氨酶、谷草转氨酶和动脉乳酸显著降低（P〈0．05）。在CRRT治疗过程中，血流动力学稳定，没有明显的副作用发生。【结论】CRRT降低热射病患者核心体温的效果确切、安全，可有效清除肌红蛋白、肌酐及清除炎症细胞因子，支持肝、肾等重要脏器功能。CRRT治疗合并多脏器功能不拿的热射病患者安全有效。

The value of continuous renal replacement therapy in heatstroke patients complicated with multiple organ dysfunction syndrome

[Objective] To investigate the value and efficacy of continuous renal replacement therapy （CRRT） of heat stroke patients complicated with multiple organ dysfunction syndrome（MODS）. [ Methods ] The clinical data of 19 cases of heatstroke patients compli- cated with multiple organ dysfunction syndrome accepted CRRT were analyzed retrospectively. CVVH mode was used in all patients and the temperature of replacement fluid range was 28~C to 32~C for 2 to 2.5 hours and then maintained at 36~C. Monitoring the temper- ature（T）, heart rate （HR）, mean arterial pressure （MAP）, APACHE ]] scores, oxygenation index（POJFiO2）, serum urea nitrogen（BUN）, creatinine （Cr）, myoglobin （Mb）, creatine kinase （CK）, glntamic-pyruvic transaminase（GPT）, glutamic-oxaloacetic transaminase（SGOT） and arterial lactate （Lac） in patients before and after CRRT. [ Results] 15 patients were cured or improved. 4 died. Compared with the data before CRRT body core temperature was significantly decrease from （41.6 ＋ 0.3）~C to （36.8 ＋- 0.2）~C（P 〈 0.05）, HR and MAP were decreased significantly. APACHE II score and POJFIO2 were significantly higher（P 〈 0.05）. BUN, Cr, Mb, CK, GPT, SGOT, Lac were significantly reduced after the treatment（P 〈 0.05）. In the process of treatment, hemodynamics was stable, and no significant side effects oppeared. [Conclusion] It was exactly effect and safe in reducing the core body temperature of heatstroke patients by CRRT treatment. It was also effective in removaling metabolites of urea nitrogen, creatinine, myoglobin, and reducing inflammatory cytokins, supporting the liver, kidneys and other vital organs. CRRT treatment was safe and effective for heatstroke patients with muhiple organ dysfunction syndrome.