连续性肾脏替代治疗毒蛇咬伤致多器官功能障碍的临床研究

目的探讨连续性肾脏替代治疗(CRRT)对毒蛇咬伤致多器官功能障碍(MODS)患者的治疗效果。方法回顾性分析2002～2010年本科收治的83例毒蛇咬伤致MODS病例,将其分为CRRT治疗组和非CRRT治疗组,酶联免疫吸附法(ELISA)检测两组患者治疗前后血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)、IL-6的水平,比较两组患者血气分析、电解质、肾功能、肝功能及预后转归的结果。结果 CRRT治疗组患者治疗后患者血清炎症因子水平明显下降(P<0.05),而非CRRT治疗组改变不明显(P>0.05),两组治疗后血清炎症因子水平比较差异有统计学意义(P<0.05);CRRT治疗组治疗后血气分析、血电解质水平及肝、肾功能较非CRRT治疗组有明显改善(P<0.05),总体治愈率也明显高于非CRRT治疗组,两组比较差异有统计学意义(P<0.05)。结论毒蛇咬伤致MODS患者及时行CRRT治疗对清除炎症因子,纠正水、电解质和酸碱平衡紊乱,改善肝肾功能效果明显,对改善MODS患者预后有显著作用。

The clinical study of the continuous renal replacement therapy on multiple organ dysfunction syndrome caused by venomous snake bite

Objective To investigate the effect of continuous renal replacement therapy(CRRT) in patients with multiple organ disorder syndrome(MODS) caused by venomous snake bite.Methods 83 cases of MODS caused by venomous snake bite were divided into CRRT treatment group and non CRRT treatment group.Plasma levels of IL-1,IL-6,and TNF-α were detected by enzyme linked immunosorbent assay(ELISA) before and after CRRT,and the outcomes of blood gas analysis,level of electrolytes,renal function and liver function were also detected.Results Plasma levels of TNF-α,IL-1,IL-6 were significantly decreased in CRRT treatment group compared with the baseline values before CRRT(P<0.05),while there was no significant change in non CRRT treatment group.The levels of TNF-α,IL-1,IL-6 after CRRT in CRRT treatment group were lower than those in non CRRT treatment group(P<0.05).Conclusion CRRT has significant role in clear inflammatory cytokines and make a prognostic improve merit for the venomous snake bite patients with multiple organ failure by venomous snake bite.