连续性静脉-静脉血液滤过治疗重度烧伤合并急性重度高钠血症

doi:10.3969/cndt.j.issn.1006-298X.2016.01.007

肾脏病与透析肾移植杂志 ›› 2016, Vol. 25 ›› Issue (1): 35-39.DOI: 10.3969/cndt.j.issn.1006-298X.2016.01.007

连续性静脉-静脉血液滤过治疗重度烧伤合并急性重度高钠血症

出版日期:2016-02-26 发布日期:2016-02-04

Effects of continuous venovenous hemofiltration on the treatment of severely burned patients with acute severe hypernatremia

Online:2016-02-26 Published:2016-02-04

摘要/Abstract

摘要：

目的：探讨连续性静脉静脉血液滤过（CVVH）治疗重度烧伤合并急性重度高钠血症的疗效观察。
方法：回顾性分析 2011年3月至2015年3月第四军医大学西京医院烧伤 ICU 13例重度烧伤合并急性重度高钠血症行CVVH治疗的患者。置换液钠梯度是通过加入3%或10% NaCl，使置换液的钠浓度低于血钠浓度8 mmol/L，以后每4h下降2 mmol/L。
结果：13例患者平均年龄491岁(39～57岁)，烧伤面积642%(440%～850%)。随访28d，死亡3例。CVVH治疗后APACHEⅡ评分[210(195～250) vs 246(220～285）,P<0001]，脉搏[1070 次/min(930～1200 次/min） vs 123 次/min(116~136 次/min),P= 0028)]、尿素氮[134 mmol/L(121～155 mmol/L） vs 227 mmol/L(154～343 mmol/L),P=0018]、肌酐(1676 μmol/L(1055～2405） μmol/L vs 2572 μmol/L(146～3990) μmol/L,P=0014]和血钠[1382 mmol/L(1383～1552 mmol/L） vs 1662 mmol/L(1609～1705 mmol/L),P<0001]较治疗前均明显改善。平均血钠纠正速率为062 mmol/(L·h)[034～089 mmol/(L·h)]，CVVH治疗48h血钠均正常。
结论：CVVH置换液钠梯度能有效治疗重症烧伤合并急性重度高钠血症。

关键词: 连续性静脉-静脉血液滤过, 烧伤, 高钠血症, 血钠纠正速率

Abstract:

Ｏｂｊｅｃｔｉｖｅ：To observe the effects of continuous venovenous hemofiltration (CVVH) on the treatment of severely burned patients with acute severe hypernatremia.
Ｍｅｔｈｏｄｏｌｏｇｙ：A total of thirteen severely burned patients with acute severe hypernatremia who received the CVVH treatment were admitted to our burned ICU between March 2011 and March 2015. The sodium concentration of the replacement fluid was adjusted by adding 3% or 10% sodium chloride. The sodium level of the replacement fluid was initially set to be lower than the serum sodium level by 8 mmol/L and was reduced by 2 mmol/L every 4 hours.
Ｒｅｓｕｌｔｓ：They were an average age of 491 years and had an average total burn surface area of 642%. 3 patients died in followup of 28day. After the CVVH treatment, all patients showed a significant reduction in APACH II score（210 (195~250) vs 246 (220~285),P<0001） and heartbeat (107 (930~120）vs 123 (116~136) bpm/min, P=0028). Likewise, the serum levels of urea and creatinine were decreased from 227 (154~343) to 134 (121~155）mmol/L (P=0018) and from 257 (146~399) μmol/L to 168 (106~241) (P=0014), respectively. The serum sodium reduction rate of 062 (034~089) mmol/L/h, all patients experienced a successful correction of hypernatremia within 48hrs.
Ｃｏｎｃｌｕｓｉｏｎ：Our results indicated that CVVH with gradient sodium replacement fluid was suitable for treating the acute severe hypernatremia in severely burned patients.

刘谊蓉,马峰,周美兰,等. 连续性静脉-静脉血液滤过治疗重度烧伤合并急性重度高钠血症[J]. 肾脏病与透析肾移植杂志, 2016, 25(1): 35-39.

LIU Yirong,MA Feng,ZHOU Melan,et al. Effects of continuous venovenous hemofiltration on the treatment of severely burned patients with acute severe hypernatremia[J]. Chinese Journal of Nephrology, Dialysis & Transplantation, 2016, 25(1): 35-39.

[1]	贾凤玉,任红旗,龚德华,等. 连续性血液净化治疗在重度烧伤患者救治中的应用[J]. 肾脏病与透析肾移植杂志, 2016, 25(1): 30-34.
[2]	张志宏，龚德华，朱冬冬，等，. 连续性静脉-静脉血液滤过对急性肾损伤患者胱抑素C浓度的影响[J]. 肾脏病与透析肾移植杂志, 2013, 22(1): 21-25.

ISSN 1006-298X CN 32-1425/R

连续性静脉-静脉血液滤过治疗重度烧伤合并急性重度高钠血症

Effects of continuous venovenous hemofiltration on the treatment of severely burned patients with acute severe hypernatremia

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 2

编辑推荐

Metrics

本文评价