连续性血液净化治疗热射病合并多器官功能障碍的临床疗效

目的 探讨连续性血液净化（CBP）技术对热射病合并多器官功能障碍综合征（MODS）的临床疗效.方法 选择热射病合并MODS患者12例,观察CBP治疗前后体温、心率、平均动脉压（MAP）、血肌酐、尿素氮、谷丙转氨酶（ALT）、谷草转氨酶（AST）、肌酸激酶（CK）、肌酸激酶同工酶（CK-Mb）的变化,计算急性生理学及慢性健康状况Ⅱ（APACHEⅡ）评分,检测CBP治疗前后血清肿瘤坏死因子α（TNF-α）和白细胞介素1β（IL-1β）的含量变化.结果 12例患者全部抢救成功,与治疗前比较,经CBP治疗12、24和48 h后,所有患者体温、心率、MAP均明显改善,APACHEⅡ评分均明显降低（均P＜0.05）;血肌酐、尿素氮、ALT、AST、CK、CK-Mb明显低于治疗前（均P＜0.05）;血清TNF-α和IL-1β水平也低于治疗前（均P＜0.05）.治疗中未出现任何不良反应.结论 CBP治疗能明显改善热射病合并MODS患者的肝肾功能,减轻心肌和骨骼肌损伤,清除体内炎症因子,稳定机体内环境,改善预后.

Clinical efficacy of continuous blood purification in treatment of heat stroke complicated with multiple organ dysfunction syndrome

Objective To investigate the clinical efficacy in the treatment of heat stroke （HS）complicated with multiple organ dysfunction syndrome （MODS） by using continuous blood purification （CBP）.Methods Twelve patients with HS complicated with MODS were included in this study and treated by continuous veno-venous hemofiltration.Body temperature （T）,heart rate （HR）,mean arterial pressure （MAP）,serum creatinine （SCr）,blood urea nitrogen （BUN）,alanine transarninase （ALT）,acetic transaminase （AST）,creatine kinase （CK）,creatine kinase-Mb （CK-Mb）,tumor necrosis factor α （TNF-α）and interleukin-1β （IL-1β） in serum were detected.Results All 12 cases were rescued successfully.Compared with baseline,the T,HR and MAP of all the patients were improved significantly after treatment with CBP at 48 h,and acute physiology and chronic health evaluation （APACHE Ⅱ） were also decreased significantly （P ＜ 0.05）.The level of SCr,BUN,ALT,AST,CK and CK-Mb of all the patients were decreased significantly after treatment （all P ＜ 0.05）.The content of serum TNF-α and IL-1β of all the patients were decreased after treatment （all P ＜ 0.05）.Any side reaction did not appear during the treatment.Conclusions CBP could significantly improve the liver,kidney and blood coagulation function of patients who suffered from HS complicated with MODS,reduce myocardial injury,clear inflammatory factor in vivo,keep internal environment stable,improve prognosis,and decrease the mortality rate,and has significant curative effects on rescuing the patients with HS complicated with MODS.