中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2014年
34期
2665-2668
,共4页
肾替代疗法%急性肾损伤%肌红蛋白%动脉%缺血
腎替代療法%急性腎損傷%肌紅蛋白%動脈%缺血
신체대요법%급성신손상%기홍단백%동맥%결혈
Renal replacement therapy%Acute kidney injury%Myoglobin%Arteris%Ischemia
目的 总结连续性肾脏替代治疗在急性下肢缺血导致的肌病肾病代谢综合征中的应用经验.方法 回顾2008年1月至2013年12月诊断为急性下肢缺血行手术治疗的患者,其中发生肌病肾病代谢综合征行连续性肾脏替代治疗(CRRT)的患者22例.总结在治疗过程中血肌红蛋白、尿量及血肌酐等指标的变化趋势,分析患者病情变化及预后.结果 22例患者术后截肢2例,死亡2例.死亡原因主要为急性肾功能衰竭、代谢性酸中毒、循环衰竭、肝功能衰竭等.患者血肌红蛋白在术后当天(21.69±26.26)mg/L较术前(8.23±18.81) mg/L显著升高,P＜0.05,尿量在术后第1天(1 106±1 095) ml较手术当日(1 975±1 350) ml显著降低,P＜0.05,血清肌酸激酶(CK)在术后第2天(9.47±10.79) KU/L较前1天(34.22±48.41) KU/L显著降低,P＜0.05,血色素在术后当日与术前比显著降低,P＜0.05,血肌酐术后保持平稳.结论 在发生肌病肾病代谢综合征的急性下肢缺血患者中,术后早期有针对性的应用连续性肾脏替代治疗可以尽早降低血肌红蛋白水平、CK水平并改善尿量,维持内环境平稳,预防肾功能进一步恶化,期待可以改善患者预后,值得推荐.
目的 總結連續性腎髒替代治療在急性下肢缺血導緻的肌病腎病代謝綜閤徵中的應用經驗.方法 迴顧2008年1月至2013年12月診斷為急性下肢缺血行手術治療的患者,其中髮生肌病腎病代謝綜閤徵行連續性腎髒替代治療(CRRT)的患者22例.總結在治療過程中血肌紅蛋白、尿量及血肌酐等指標的變化趨勢,分析患者病情變化及預後.結果 22例患者術後截肢2例,死亡2例.死亡原因主要為急性腎功能衰竭、代謝性痠中毒、循環衰竭、肝功能衰竭等.患者血肌紅蛋白在術後噹天(21.69±26.26)mg/L較術前(8.23±18.81) mg/L顯著升高,P＜0.05,尿量在術後第1天(1 106±1 095) ml較手術噹日(1 975±1 350) ml顯著降低,P＜0.05,血清肌痠激酶(CK)在術後第2天(9.47±10.79) KU/L較前1天(34.22±48.41) KU/L顯著降低,P＜0.05,血色素在術後噹日與術前比顯著降低,P＜0.05,血肌酐術後保持平穩.結論 在髮生肌病腎病代謝綜閤徵的急性下肢缺血患者中,術後早期有針對性的應用連續性腎髒替代治療可以儘早降低血肌紅蛋白水平、CK水平併改善尿量,維持內環境平穩,預防腎功能進一步噁化,期待可以改善患者預後,值得推薦.
목적 총결련속성신장체대치료재급성하지결혈도치적기병신병대사종합정중적응용경험.방법 회고2008년1월지2013년12월진단위급성하지결혈행수술치료적환자,기중발생기병신병대사종합정행련속성신장체대치료(CRRT)적환자22례.총결재치료과정중혈기홍단백、뇨량급혈기항등지표적변화추세,분석환자병정변화급예후.결과 22례환자술후절지2례,사망2례.사망원인주요위급성신공능쇠갈、대사성산중독、순배쇠갈、간공능쇠갈등.환자혈기홍단백재술후당천(21.69±26.26)mg/L교술전(8.23±18.81) mg/L현저승고,P＜0.05,뇨량재술후제1천(1 106±1 095) ml교수술당일(1 975±1 350) ml현저강저,P＜0.05,혈청기산격매(CK)재술후제2천(9.47±10.79) KU/L교전1천(34.22±48.41) KU/L현저강저,P＜0.05,혈색소재술후당일여술전비현저강저,P＜0.05,혈기항술후보지평은.결론 재발생기병신병대사종합정적급성하지결혈환자중,술후조기유침대성적응용련속성신장체대치료가이진조강저혈기홍단백수평、CK수평병개선뇨량,유지내배경평은,예방신공능진일보악화,기대가이개선환자예후,치득추천.
Objective To summarize the experiences of using continuous renal replacement therapy in the treatment of myonephropathic metabolic syndrome caused by acute lower limb ischemia.Methods Retrospective study of patients diagnosed acute lower limb ischemia with surgical treatment between January 2008 and December 2013,among which 22 patients with myonephropathic metabolic syndrome received continuous renal replacement therapy.Summarize the change tendency of myoglobin,urine volume and serum creatinine levels during treatment and analysis the condition changes and prognosis of the patients.Results Among them,2 patients were amputated and two died after surgery.The major causes of death were acute renal failure,metabolic acidosis,circulation failure and liver failure,etc.Myoglobin was significantly higher at Day 1 after surgery than that was before surgery (P ＜ 0.05).Urine volume was significantly lower at Day 1 after surgery than that on the day of surgery (P ＜ 0.05).CK was significantly lower at Day 2 after surgery than the day before (P ＜ 0.05).Hemoglobin was significantly lower at Day 1 after surgery than that before surgery (P ＜ 0.05).Serum creatinine levels remained steady.Conclusion In patients of acute lower limb ischemia with myonephropathic metabolic syndrome,early targeted continuous renal replacement therapy may decrease the serum concentrations of myoglobin and CK,improve urine volume,maintain homeostasis,prevent renal function deterioration and improve the prognosis of patients.And it is highly recommended.
