特重度烧伤并发急性肾功能衰竭的因素分析

目的探讨特重度烧伤并发急性肾功能衰竭(acute renal failure,ARF)的相关因素,为临床早期防治ARF提供依据。方法分析我科2003年1月至2012年12月收治的特重度烧伤362例烧伤后开始接受液体复苏治疗的时间和方法,并结合测定的生化指标,分析特重度烧伤与ARF的相关性。结果 362例特重度烧伤中有27例并发ARF,烧伤面积>90%组ARF发生比例明显高于其他各组(P<0.05)。烧伤面积>70%组,伤后2 h以后开始接受液体复苏治疗组发生ARF明显高于伤后2 h以内开始治疗组(P<0.05)。发生ARF者,血尿素氮(BUN)在伤后14 d明显高于无ARF者(P<0.05),血肌酐(Scr)在伤后7 d明显高于无ARF者(P<0.05),胱抑素C(CysC)在伤后2 d明显高于无ARF者(P<0.05)。结论烧伤面积和伤后液体复苏开始治疗时间均与烧伤并发ARF呈正相关,发生ARF时患者BUN、Scr、CysC均明显升高,CysC测定可能成为早期检测ARF的敏感指标。

Analysis of the factors of severe burn complicated with acute renal failure

Objective Through investigation the related factors of acute renal failure（ARF） with severely thermal burn, and provide evidence for clinical early prevention and treatment of ARF. Methods 362 cases data with ARF admitted into our department during January 2003 to December 2012 with severely thermal burn were enrolled to analyze the time and method began to receive fluid resuscitation therapy, combined with their biochemical index determination, to analyze the correlation of severely thermal burn with ARF. Results In 362 cases of severely thermal burn patients were 27 cases complicated with ARF, and the ARF incidence of burn area more than 90%was significantly higher than the other groups （P〈0.05）. In burn area more than 70%group, the ARF incidence of 2 hours after injury began to accept fluid resuscitation group was significantly higher than within 2 hours after injury to the treatment group （P〈0.05）. In 27 cases of ARF, blood urea nitrogen index （BUN） at 14 days after injury, serum creatinine （Scr） index in 7 days after injury, Cystatin C （CysC） index in 2 days after injury were significantly higher than those without ARF（P〈0.05）. Conclusion Burn area and wound fluid resuscitation began treatment time were positively correlated with burn complicated with ARF, and with the occurrence of ARF the index of BUN, Scr, CysC were significantly increased, so CysC determination may be sensitive markers for early detection of ARF.