CAJ | 학술논문

目的：探讨持续肾脏替代治疗（CRRT）联合血液灌流（HP）治疗急性重症病毒性心肌炎（ SAVM）的效果。方法选取2010年1月—2012年12月西安交通大学第一附属医院行 CRRT 联合 HP 治疗的7例 SAVM 患者为研究对象，患者治疗前均行心电图、超声心动图检查，监测治疗前和治疗后72 h 心肌酶谱、B 型脑钠肽氨基末端前体（NT - proBNP）、肝肾功能和凝血指标。结果患者治疗后乳酸脱氢酶（ LDH）、肌酸激酶（ CK）、肌酸激酶同工酶（CK - MB）、NT - proBNP 水平均低于治疗前，差异有统计学意义（P ＜0.05）。在行 CRRT 联合 HP 治疗过程中根据患者血流动力学状况调整每日超滤量，在血流动力学稳定情况下维持液体负平衡，患者治疗总的液体平衡为（-888±1538）ml。治疗前有5例出现肝功能损害，丙氨酸氨基转移酶（ ALT）、天冬氨酸氨基转移酶（ AST）升高，经CRRT 联合 HP 治疗后4例下降；治疗前有3例出现肾损害，经 CRRT 联合 HP 治疗后均好转，尿量正常；2例患者治疗后凝血酶原时间（PT）缩短。结论 CRRT 联合 HP 技术治疗 SAVM 可改善患者临床症状，心脏功能改善，心律失常消失，血流动力学稳定，同时受损的肝肾功能也得到不同程度的改善。
목적：탐토지속신장체대치료（CRRT）연합혈액관류（HP）치료급성중증병독성심기염（ SAVM）적효과。방법선취2010년1월—2012년12월서안교통대학제일부속의원행 CRRT 연합 HP 치료적7례 SAVM 환자위연구대상，환자치료전균행심전도、초성심동도검사，감측치료전화치료후72 h 심기매보、B 형뇌납태안기말단전체（NT - proBNP）、간신공능화응혈지표。결과환자치료후유산탈경매（ LDH）、기산격매（ CK）、기산격매동공매（CK - MB）、NT - proBNP 수평균저우치료전，차이유통계학의의（P ＜0.05）。재행 CRRT 연합 HP 치료과정중근거환자혈류동역학상황조정매일초려량，재혈류동역학은정정황하유지액체부평형，환자치료총적액체평형위（-888±1538）ml。치료전유5례출현간공능손해，병안산안기전이매（ ALT）、천동안산안기전이매（ AST）승고，경CRRT 연합 HP 치료후4례하강；치료전유3례출현신손해，경 CRRT 연합 HP 치료후균호전，뇨량정상；2례환자치료후응혈매원시간（PT）축단。결론 CRRT 연합 HP 기술치료 SAVM 가개선환자림상증상，심장공능개선，심률실상소실，혈류동역학은정，동시수손적간신공능야득도불동정도적개선。
Objective To evaluate the efficacy of continuous renal replacement therapy(CRRT)plus hemoperfusion (HP)in patients with severe acute virus myocarditis(SAVM). Methods We enrolled 7 SAVM patients who received CRRT plus HP in the First Affiliated Hospital of Xi'an Jiaotong University from January 2010 to December 2012. Electrocardiogram and ultrasonic cardiogram were examined before treatment. A series of indicators were also monitored before and 72 h after treatment, including myocardial enzymogram,NT - proBNP,liver and kidney function and blood coagulation. Results The levels of LDH,CK,CK - MB and NT - proBNP of the subjects declined after treatment(P < 0. 05). During the treatment,the daily amount of ultrafiltration was adjusted according to hemodynamic status,and negative fluid balance was maintained in the case of stable hemodynamic status. The overall value for fluid balance was( - 888 ± 1 538)ml. Liver function damage occurred in 5 subjects with evident rise in ALT and AST before treatment,among which 4 subjects experienced decline in the two indicators after treatment. Kidney function damage occurred in 3 subjects,all of which recovered after treatment with normal urine volume. Shortened PT was noted in 2 subjects after treatment. Conclusion CRRT plus HP could effectively alleviate the clinic symptoms in SAVM patients,including the improvement of cardiac function,the disappearance of arrhythmia,stable hemodynamic status and the recovering of liver and renal function to varying degrees.