连续性肾脏替代疗法治疗严重烧伤并吸人性化学中毒疗效观察

目的 观察连续性肾脏替代疗法（CRRT）治疗严重烧伤合并吸人性化学中毒的临床疗效及对患者血液生化指标、细胞因子水平的影响.方法 60例烧伤并吸人性化学中毒患者在知情同意情况下按入院单双号随机分为治疗组和对照组各30例,对照组采用烧伤常规治疗方法,治疗组加用CRRT治疗,平均2～3次.观察比较两组临床疗效及治疗前后生化指标和细胞因子水平变化.结果 治疗组治疗后心率、动脉血氧分压、尿素氮、血肌酐水平分别为（110.0±26.0）次/min、（93.3±11.0）mm Hg、（6.1±1.3）mmol/L、（106.4±24.8）μmol/L,较治疗前的（148.0±38.0）次/min、（84.5±9.1）mm Hg、（8.6±1.9）mmoL/L、（172.6±29.8）μmol/L有明显改善（t=2.154、2.345、2.458、2.544,均P＜0.05）,与对照组治疗后的（133.0±37.O）次/min、（86.5±9.9）mm Hg、（8.3±2.0）mmol/L、（134.6±26.8）μmol/L差异均有统计学意义（t=2.174、2.245、2.558、2.444,均P＜0.05）;治疗组治疗后白细胞介素-1、-6、-8及肿瘤坏死因子-α水平（260.7 ±25.9）ng/L、（327.6 ±129.2）ng/L、（300.3±146.6）ng/L、（97.1±22.3）ng/L]与对照组治疗后（368.2±24.8）ng/L、（400.2 ±198.3）ng/L、（482.9 ±198.5）ng/L、（225.0±22.3）ng/L]差异均有统计学意义（t=2.314、2.371、2.278、2.316,均P＜0.05）.结论 CRRT治疗可以清除严重烧伤患者炎性介质和细胞因子,维持内环境稳定.

Clinical research of severe burn patients with chemical poisoning treatment by continuous renal replacement therapy

Objective To investigate the influence of biochemical indices and coagulation function in severe burn patients with chemical poisoning by continuous renal replacement therapy(CRRT)treatment.Methods 60 patients were randomly divided into CRRT treatment group(n=30)and basic therapy(n=30).The control group received conventional treatment,based therapies in the treatment group based on the use CRRT treatment,the average course of 2 or 3 times to observe the biochemical indicators coagulation,and cytokine before treatment compared with that after treatment.Results In treatment group,the index of heart rate,arterial partial pressure of oxygen,blood urea nitrogen,serum creatinine after treatment(110.0±26.0)times/min,(93.3±11.0)mm Hg,(6.1 ±1.3)mmol/L,(106.4±24.8)μmol/L],compared with before treatment(148.0±38.0)times/min、(84.5 9.1)mm Hg,(8.6±1.9)mmol/L,(172.6 ±29.8)μmol/L]were significantly different(t=2.154,2.345、2.458,2.544,all P＜0.05),and compared with control group(133.0±37.0)times/min,(86.5 ±9.9)mm Hg,(8.3 ±2.0)mmol/L,(134.6±26.8)μmol/L]were statistically significant(t=2.174,2.245,2.558,2.444,all P＜0.05);The index of IL-1,IL-6,IL-8,TNF-α after treatment in treatment group(260.7 ±25.9)ng/L,(327.6±129.2)ng/L,(300.3±146.6)ng/L,(97.1±22.3)ng/L)compared with control group after treatment(368 .2±24.8)ng/L,(400.2±198.3)ng/L,(482.9±198.5)ng/L,(225.0 ±22.3)ng/L]had significant differences(t=2.314、2.371、2.278、2.316,all P＜0.05).Conclusion The treatment group of patients with severe burns could remove the inflammatory mediators and cywkines,to improve their inflammatory state and maintain stability in the environment.