大面积烧伤合并脓毒症行连续性肾替代疗法的探讨

目的 探讨大面积烧伤合并烧伤脓毒症行连续性肾替代疗法（CRRT）的时机和价值.方法 将新疆维吾尔自治区人民医院2002年10月至2010年10月收治的33例大面积烧伤合并脓毒症患者按治疗方法不同分为试验组（A组）17例和对照组（B组）16例,两组患者确诊烧伤脓毒症后均行CRRT治疗24 h,随后A组急诊行切痂植皮术,术后继续CRRT治疗.B组连续行CRRT治疗48 h.观察两组患者CRRT治疗前及治疗后24 h、32 h、48 h生命体征（体温、心率、呼吸）、血清生化指标（钠、氯、尿素氮、肌酐、动脉血氧分压）的变化及病死率.结果 两组行CRRT治疗前生命体征和血清生化指标比较差异无统计学意义（P＞0.05）,行CRRT治疗后24 h生命体征和血清生化指标均较治疗前有所改善,但差异仍无统计学意义（P＞0.05）.A 组治疗后32 h、48 h（手术切痂植皮后8 h、24 h）相关血清生化指标开始下降,各项生命体征趋于平稳,与B组相比差异有统计学意义（P＜0.05）.B组病死率（56.25%）明显高于A组（23.52%）,差异有高度统计学意义（P＜0.01）.结论 及时、彻底的清创和有效的创面封闭,是救治大面积烧伤合并脓毒症的关键措施,CRRT在围手术期应用可降低急诊切痂手术的风险性,但无法根本逆转烧伤脓毒症病情的继续发展,不可过分依赖.

Continuous renal replacement therapy in large area burn combined with burn sepsis

Objective To discuss the timing and value of continuous renal replacement therapy （CRRT） in large area burn combined with burn sepsis. Methods All the 33 large area burn combined with burn sepsis patients were selected who were hospitalized during October 2002 to October 2010. All the patients were divided on therapy into experimental group （group A, 17 cases） and control group （group B, 16 cases）. Both groups were given CRRT and then group A given emergent eschareetomy, group B continued CRRT. Vital signs （ temperature, body temperature, respiration） , serum biochemical parameters （ sodium, chloride, urea nitrogen, creatinine, arterial oxygen partial pressure ） of two groups were observed before CRRT and after treatment 24 h, 32 h, 40 h. Results There was no significant difference between two groups in vital sign and serum biochemical parameters before CRRT （P 〉 0.05 ） , after 24 hours＇ CRRT, the vital sign and serum biochemical parameters were improved but the two groups also had no significant difference （P〉0. 05）. After 32 and 40 hours＇ CRRT in group A （8 h, 16 h after cscharectomy）, the patients＇ serum biochemical parameters started to decline, the vital signs stabilized and there were significant differences between group A and group B （P 〈 0.05 ）. The mortality of group B （56.25%） was signifieantly higher than group A （23.52%）, and they had significant differences （P 〈 0. 01 ）. Conclusions The key measures of burn sepsis combined with large area bum are timely and thorough wound debridement and effective closure. CRRT in the perioperative period can reduce the risk of emergent esehareetomy, but can not reverse the development of bum sepsis and can not be over-dependent.