連續(xù)性血液凈化治療重癥燒傷后高鈉血癥

摘要： 目的探討連續(xù)性血液凈化治療燒傷后高鈉血癥的治療效果。方法回顧性分析24例接受連續(xù)性靜脈-靜脈血液濾過(guò)(CVVH)治療的重癥燒傷后高鈉血癥患者的臨床資料。高鈉血癥診斷標(biāo)準(zhǔn):1天內(nèi)連續(xù)2次外周靜脈血鈉濃度>150mmol/L。治療使用床旁連續(xù)性血液凈化治療機(jī),抗凝使用低分子肝素或無(wú)肝素。置換液為前置換,置換液流量2～4L/h。測(cè)定治療前后心率、體溫、平均動(dòng)脈壓、氧飽和度、氧合指數(shù)、碳酸氫根、血肌酐、尿素氮、血鈉、血乳酸等。結(jié)果 24例燒傷后高鈉血癥患者中存活11例。經(jīng)CVVH治療后,患者體溫、心率降低,平均動(dòng)脈壓提高,血氧改善,血尿素氮、肌酐水平較治療前明顯降低。血鈉從第6小時(shí)后逐漸下降,治療前后血鈉比較[(163.3±9.1)mmol/L:(146.4±2.3)mmol/L];置換液前后比較(149.8±5.6)mmol/L:(142.0±2.1)mmol/L]差異顯著。結(jié)論 CVVH用于救治燒傷后高鈉血癥的患者療效確切,在糾正高鈉血癥同時(shí),可提高肺換氣功能,穩(wěn)定水、電解質(zhì)及酸堿平衡。早期治療可能取得更好的療效。
Objective To observe the therapeutic effect of continues blood purification in burnt patients with hypernatremia. Methods Blood sodium >150mmol/L two times in one day was defined hypernatremia.Total 24 burnt patients with hypernatremia received CVVH,Replacement solution infused rate was 2-4L/h.Before and after CVVH, level of the HR,TEM,MAP,SPO_2,PaO_2/FiO_2,HCO_3~-,LAC and main biochemical indicator in plasma were all measured.Results 11 of 24 patients were survived。After CVVH,the level of the HR,TEM,Bun,Scr,and LAC decreased obviously (P<0.01).MAP,PaO_2/FiO_2,were significantly higher than the pretherapy (P<0.01).Before and after CVVH,Blood sodium level was [(163.3±9.1) mmol/L vs.(146.4±2.3) mmol/L,P<0.01].Conclusion CVVH play an important role in the therapy of burnt patients with hypernatremia,which can improve the air exchange function of lung and keep the stability of water-electrolyte and acid-base.Early intervent with CVVH in a critically burn population with hypernatremia,and maybe get better survival.