血液滤过联合血液灌流治疗对横纹肌溶解综合征并急性肾损伤患者的疗效研究
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摘要
目的探讨血液滤过联合血液灌流用于横纹肌溶解综合症合并急性肾损伤(Rhabdomyolysis syndrome associated with Acute KidneyInjury)治疗的近期疗效.
方法选取21例典型横纹肌溶解综合症合并急性肾损伤患者,在右侧股静脉置管后行血液滤过联合血液灌流治疗,于治疗前后观察相关临床指标(体温、心率、平均动脉压、末梢氧饱和度、ATN-ISI评分、SAPSII评分),以及相关生化指标(血钠、血钾、血糖、血尿素氮、血肌酐、血肌红蛋白、血肌酸激酶等),比较上述指标以来评价横纹肌溶解综合征并急性肾损伤患者行血液滤过联合血液灌流治疗的疗效,数据用SPSS16.0统计软件进行t检验。
结果全部病例经血液滤过联合血液灌流治疗后全部存活。治疗后所有病例心率、末梢氧饱和度、体温均稳定在正常范围。治疗后血尿素氮及血肌酐值较治疗前有显著的下降(P<0.01)。治疗后病人平均动脉压较治疗前有显著的升高(P<0.01)。治疗结束时患者的血钾、血钠及血糖值稳定与正常水平,并且趋近于置换液中相应溶质的浓度；血肌红蛋白、血肌酸激酶值明显下降。治疗后患者的SAPSII评分以及ATN-ISI评分均有显著性下降。
结论血液滤过联合血液灌流治疗横纹肌溶解综合征合并急性肾损伤患者有着良好的近期疗效。
Object:To discuss the term effect of hemofiltration combined hemoperfusion in Rhabdomyolysis syndrome associated with Acute Kidney Injury.
Method:Choosing 21 typical patients with Rhabdomyolysis syndrome associated with Acute Kidney Injury, accepting High-volume hemofiltration with deep-vein indwelling catheter in right femoral veins. We evaluated heart rate, body temperature, mean arterial pressure, ATN-ISI score, SAPSII score and potassium, sodium, glucose, serum creatinine, blood urea nitrogen, serum myoglobin and so on, and compared them to estimate the term effect of hemofiltration combined hemoperfusion in Rhabdomyolysis syndrome associated with Acute Kidney Injury. Statistics analysis adopt SPSS 16.0. Statistical methods use t-test.
Result:All the 21 cases after all the hemofiltration combined hemoperfusion survived. Their heart rate, oxygen saturation and temperature were in normal range. Their serum creatinine, blood urea nitrogen and serum myoglobin decreased significantly(P<0.01),.and MAP increased significantly. (P<0.01). And their potassium, sodium and glucose tended to be concentration in repalacement liquid. Their ATN-ISI score and SAPSII score also decreased significantly(P<0.01).
Conclusion:The term effects of hemofiltration combined hemoperfusion in Rhabdomyolysis syndrome associated with Acute Kidney Injury were favourable.
方法选取21例典型横纹肌溶解综合症合并急性肾损伤患者,在右侧股静脉置管后行血液滤过联合血液灌流治疗,于治疗前后观察相关临床指标(体温、心率、平均动脉压、末梢氧饱和度、ATN-ISI评分、SAPSII评分),以及相关生化指标(血钠、血钾、血糖、血尿素氮、血肌酐、血肌红蛋白、血肌酸激酶等),比较上述指标以来评价横纹肌溶解综合征并急性肾损伤患者行血液滤过联合血液灌流治疗的疗效,数据用SPSS16.0统计软件进行t检验。
结果全部病例经血液滤过联合血液灌流治疗后全部存活。治疗后所有病例心率、末梢氧饱和度、体温均稳定在正常范围。治疗后血尿素氮及血肌酐值较治疗前有显著的下降(P<0.01)。治疗后病人平均动脉压较治疗前有显著的升高(P<0.01)。治疗结束时患者的血钾、血钠及血糖值稳定与正常水平,并且趋近于置换液中相应溶质的浓度；血肌红蛋白、血肌酸激酶值明显下降。治疗后患者的SAPSII评分以及ATN-ISI评分均有显著性下降。
结论血液滤过联合血液灌流治疗横纹肌溶解综合征合并急性肾损伤患者有着良好的近期疗效。
Object:To discuss the term effect of hemofiltration combined hemoperfusion in Rhabdomyolysis syndrome associated with Acute Kidney Injury.
Method:Choosing 21 typical patients with Rhabdomyolysis syndrome associated with Acute Kidney Injury, accepting High-volume hemofiltration with deep-vein indwelling catheter in right femoral veins. We evaluated heart rate, body temperature, mean arterial pressure, ATN-ISI score, SAPSII score and potassium, sodium, glucose, serum creatinine, blood urea nitrogen, serum myoglobin and so on, and compared them to estimate the term effect of hemofiltration combined hemoperfusion in Rhabdomyolysis syndrome associated with Acute Kidney Injury. Statistics analysis adopt SPSS 16.0. Statistical methods use t-test.
Result:All the 21 cases after all the hemofiltration combined hemoperfusion survived. Their heart rate, oxygen saturation and temperature were in normal range. Their serum creatinine, blood urea nitrogen and serum myoglobin decreased significantly(P<0.01),.and MAP increased significantly. (P<0.01). And their potassium, sodium and glucose tended to be concentration in repalacement liquid. Their ATN-ISI score and SAPSII score also decreased significantly(P<0.01).
Conclusion:The term effects of hemofiltration combined hemoperfusion in Rhabdomyolysis syndrome associated with Acute Kidney Injury were favourable.
引文
[1]Gabow P A. The spectrum ofrhabdomyolysis[J]. Medicine (Baltimore),1982, (3):141-152.
[2]Abassi ZA, Hoffman A. Better os Acute renal failure compli-cating muscle crush injury. Nephral,1998,18:558-565
[3]Cheng T S,Ko W H,Swaminathan R, et al.Effect of lysine on hemodialysis induced kidney damage[J].J Lab Clin Med,1992,119:496502.
[4]Moure K P,Holt S G,Patel H P,et al. Acausatiue role for redox cycling of myoglobin and its inhibition by alkalinization in the pathogenesis and treatment of rhabdomyolysis induced renal failure[J]. J Biol Chen,1998,273:3173131737.
[5]王丽.急性横纹肌溶解并发性肾功能衰竭的血液净化治疗[J].国外医学.移植与血液净化分册,2004,6(2)：21-23.
[6]郭伟.非创伤性横纹肌溶解致急性肾衰竭的血液净化治疗[J].中华急诊医学杂志,2002.11(1)：58-60.
[7]王海燕,主编.肾衰竭[M].上海：上海科学技术出版社,2003.92 96
[8]Knash M, Tsang A, Hameed B, et al. cerebral blood volume is predictive of diffusion restriction only in hyperacute stroke. [J] Stroke.2010 Dec;41(12):2795-800. Epub 2010 Nov 4.
[9]Moure KP, Holt SG, Patel HP, et al. Acausatiue role for re-dox cycling of myoglobin and its inhibition by alkalinization in the pathogenesis and treatment of rhabdomyolysis induced renal failure. J Biol Chen,1998,273:31731-31737
[10]M E Cianfrocca, K A Kimmel et al.Phase 1 trial of the antiang-iogenic peptide ATN-161 (Ac-PHSCN-NH2), a beta integrin antagonist, in patients with solid tumours.British Journal of Cancer (2006) 94,1621-1626
[11]Barbieri,A, Pinna,C Basso,GP Molinari,R et al. Specificity and reliability of prognostic indexes in intensive care evaluation:the spontaneous cerebral haemorrhage case. Journal of evaluation in clinical practice(2009).5
[12]Lima RS, da Silva Junior GB, Liborio AB, et al.Acute kidneyinjury due to rhabdmayolysis[J].Saudi J Kidney Dis Transpl,2008.19:721-729.
[13]孟建中,张永寿,葛延明,等.过度训练致横纹肌溶解症并发急性肾衰竭的相关因素分析[J].实用医药杂志,2004,21：769-773.
[14]Huerta-Alardin AL, Varon J, Marik PE.Bench-to-bedsido review Rhabdomyolysis-an overview for clinicians[J].Crit Care,2005,9:158-169.
[15]岳慧,宋青,纪筠,等.肌酸激酶浓度在劳力性热射病发生早期判别预后的研究[J].军医进修学院学报,2008,29：457-459.
[16]Veenstra J,Smith WM,Krediet RT,et al.Relationship between elevated creatine phosphokinase and the clinical spectrum of rhabdomyolysis[J].Nephrol Dial Transplant,1994,9(6):637-641.
[17]Gabow PA,Kaehny WD,KelleherSP.The spectrum ofrhabdomyolysis[J].Medicine, 1982,61 (3):141-152[18]Harper J.RhabdomyOlysiS and acute renal failure[J].Crit Care Nurse,1990,10:32-36.
[19]Fernandeg WG,Hung O,Bruno R.Factors predicative of acute renal failure and need for hemodialysis among ED patients with rhabdomyolysis [J].Am J Emerg Med,2005,23(5):111-117.
[20]Banasik M,Kuzniar J,Kusztal M,et al.Myoglobinuria caused by exertional rhabdomyolysis misdiagnosed as psychiatric illness[J].Med Sci Monit.2008,14: 1-4.
[21]Harper J.RhabdomyOlysiS and acute renal failure[J].Crit Care Nurse,1990,10: 32-36.
[1]Lima RS,da Silva Junior GB,Liborio AB,et al.Acute kidneyinjury due to rhabdmayolysis[J].Saudi J Kidney Dis Transpl,2008,19:721-729.
[2]Veenstra J,Smith WM,Krediet RT,et al.Relationship between elevated creatine phosphokinase and the clinical spectrum of rhabdomyolysis[J].Nephrol Dial Transplant,1994,9(6):637-641.
[3]孟建中,张永寿,葛延明,等.过度训练致横纹肌溶解症并发急性肾衰竭的相关因素分析[J].实用医药杂志,2004,21：769-773.
[4]Lima RS,da Si lva Junior GB,Liborio AB, et al.Acute kidneyinjury due to rhabdmayolysis[J].Saudi J Kidney Dis Transpl,2008.19:721-729.
[5]Huerta-Alardin AL,Varon J,Marik PE.Bench-to-bedsido reviewRhabdomyolysis-an overview for clinicians[J].Crit Care,2005,9:158-169.
[6]岳慧,宋青,纪筠,等.肌酸激酶浓度在劳力性热射病发生早期判别预后的研究[J].军医进修学院学报,2008,29：457-459.
[7]Gabow PA,Kaehny WD,KelleherSP.The spectrum ofrhabdomyolysis[J].Medicine, 1982,61(3):141-152
[8]Harper J.RhabdomyOlysiS and acute renal failure[J].Crit Care Nurse,1990,10:3 2-36.
[9]Banasik M,Kuzniar J,Kusztal M,et al.Myoglobinuria caused by exertional rhabdomyolysis misdiagnosed as psychiatric illness[J].Med Sci Monit.2008,14: 1-4.
[10]Mehta RL,Kel lum JR,Shah SV,et al.Acute Kidrley Injury Network:report of an initiatire to improve outcomes in acute kidney injury[J].Crit Care,2007,11:R31.
[11]陈楠,张文,余海瑾,等.急性肾功能衰竭的流行病学研究[J].上海医学,2001,24(4)：239-242
[12]王丽.急性横纹肌溶解并发性肾功能衰竭的血液净化治疗[J].国外医学.移植与血液净化分册,2004,6(2)：21-23.
[13]郭伟.非创伤性横纹肌溶解致急性肾衰竭的血液净化治疗[J].中华急诊医学杂志,2002.11(1)：58-60.
[14]杨明浩,郝江,乌胜平.横纹肌溶解症并发急性肾功能衰竭的研究进展.解放军医学杂志,2006,6,31,212-216.
[15]Glycerol-induced acute renal failure in the rat [J].Am J Respir Crit Care Med,1997,156(4):1265-1269.
[16]Lochhead KM, Kharasch ED, Zager RA.Anesthetic effects on the glycerol model of rhabdomyolysis-induced acute renal failure in rats[J].J Am Soc Nephrol,1998,9 (2):305-309.
[17]Stefanovic V,Save V,Vlahovic P.et al.Reversal of experimental myoglobinuric acute renal failure with bioflavonoids from seeds of grape[J].Ren Fail.2000, 22(5):255-266.
[18]张训.侯凡凡主编.危重症肾脏病学.北京：人民卫生出版社,2009.2.
[19]喻业安,夏瑗瑜,张野.横纹肌溶解症导致急性肾衰竭的临床分析[J].中国血液净化杂志,2003,2(8)：443-444..
[20]Fernandeg WG,Hung O,Bruno R.Factors predicative of acute renal failure and need for hemodialysis among ED patients with rhabdomyolysis [J].Am J Emerg Med,2005,23(5):111-117.
[21]Bonventre JV,Weinberg JM.Recent Advance in the Pathophysiology of Ischemic Acute Renal Failure,J Am Nephrol,2003,14(8):2199-2210.
[2]Abassi ZA, Hoffman A. Better os Acute renal failure compli-cating muscle crush injury. Nephral,1998,18:558-565
[3]Cheng T S,Ko W H,Swaminathan R, et al.Effect of lysine on hemodialysis induced kidney damage[J].J Lab Clin Med,1992,119:496502.
[4]Moure K P,Holt S G,Patel H P,et al. Acausatiue role for redox cycling of myoglobin and its inhibition by alkalinization in the pathogenesis and treatment of rhabdomyolysis induced renal failure[J]. J Biol Chen,1998,273:3173131737.
[5]王丽.急性横纹肌溶解并发性肾功能衰竭的血液净化治疗[J].国外医学.移植与血液净化分册,2004,6(2)：21-23.
[6]郭伟.非创伤性横纹肌溶解致急性肾衰竭的血液净化治疗[J].中华急诊医学杂志,2002.11(1)：58-60.
[7]王海燕,主编.肾衰竭[M].上海：上海科学技术出版社,2003.92 96
[8]Knash M, Tsang A, Hameed B, et al. cerebral blood volume is predictive of diffusion restriction only in hyperacute stroke. [J] Stroke.2010 Dec;41(12):2795-800. Epub 2010 Nov 4.
[9]Moure KP, Holt SG, Patel HP, et al. Acausatiue role for re-dox cycling of myoglobin and its inhibition by alkalinization in the pathogenesis and treatment of rhabdomyolysis induced renal failure. J Biol Chen,1998,273:31731-31737
[10]M E Cianfrocca, K A Kimmel et al.Phase 1 trial of the antiang-iogenic peptide ATN-161 (Ac-PHSCN-NH2), a beta integrin antagonist, in patients with solid tumours.British Journal of Cancer (2006) 94,1621-1626
[11]Barbieri,A, Pinna,C Basso,GP Molinari,R et al. Specificity and reliability of prognostic indexes in intensive care evaluation:the spontaneous cerebral haemorrhage case. Journal of evaluation in clinical practice(2009).5
[12]Lima RS, da Silva Junior GB, Liborio AB, et al.Acute kidneyinjury due to rhabdmayolysis[J].Saudi J Kidney Dis Transpl,2008.19:721-729.
[13]孟建中,张永寿,葛延明,等.过度训练致横纹肌溶解症并发急性肾衰竭的相关因素分析[J].实用医药杂志,2004,21：769-773.
[14]Huerta-Alardin AL, Varon J, Marik PE.Bench-to-bedsido review Rhabdomyolysis-an overview for clinicians[J].Crit Care,2005,9:158-169.
[15]岳慧,宋青,纪筠,等.肌酸激酶浓度在劳力性热射病发生早期判别预后的研究[J].军医进修学院学报,2008,29：457-459.
[16]Veenstra J,Smith WM,Krediet RT,et al.Relationship between elevated creatine phosphokinase and the clinical spectrum of rhabdomyolysis[J].Nephrol Dial Transplant,1994,9(6):637-641.
[17]Gabow PA,Kaehny WD,KelleherSP.The spectrum ofrhabdomyolysis[J].Medicine, 1982,61 (3):141-152[18]Harper J.RhabdomyOlysiS and acute renal failure[J].Crit Care Nurse,1990,10:32-36.
[19]Fernandeg WG,Hung O,Bruno R.Factors predicative of acute renal failure and need for hemodialysis among ED patients with rhabdomyolysis [J].Am J Emerg Med,2005,23(5):111-117.
[20]Banasik M,Kuzniar J,Kusztal M,et al.Myoglobinuria caused by exertional rhabdomyolysis misdiagnosed as psychiatric illness[J].Med Sci Monit.2008,14: 1-4.
[21]Harper J.RhabdomyOlysiS and acute renal failure[J].Crit Care Nurse,1990,10: 32-36.
[1]Lima RS,da Silva Junior GB,Liborio AB,et al.Acute kidneyinjury due to rhabdmayolysis[J].Saudi J Kidney Dis Transpl,2008,19:721-729.
[2]Veenstra J,Smith WM,Krediet RT,et al.Relationship between elevated creatine phosphokinase and the clinical spectrum of rhabdomyolysis[J].Nephrol Dial Transplant,1994,9(6):637-641.
[3]孟建中,张永寿,葛延明,等.过度训练致横纹肌溶解症并发急性肾衰竭的相关因素分析[J].实用医药杂志,2004,21：769-773.
[4]Lima RS,da Si lva Junior GB,Liborio AB, et al.Acute kidneyinjury due to rhabdmayolysis[J].Saudi J Kidney Dis Transpl,2008.19:721-729.
[5]Huerta-Alardin AL,Varon J,Marik PE.Bench-to-bedsido reviewRhabdomyolysis-an overview for clinicians[J].Crit Care,2005,9:158-169.
[6]岳慧,宋青,纪筠,等.肌酸激酶浓度在劳力性热射病发生早期判别预后的研究[J].军医进修学院学报,2008,29：457-459.
[7]Gabow PA,Kaehny WD,KelleherSP.The spectrum ofrhabdomyolysis[J].Medicine, 1982,61(3):141-152
[8]Harper J.RhabdomyOlysiS and acute renal failure[J].Crit Care Nurse,1990,10:3 2-36.
[9]Banasik M,Kuzniar J,Kusztal M,et al.Myoglobinuria caused by exertional rhabdomyolysis misdiagnosed as psychiatric illness[J].Med Sci Monit.2008,14: 1-4.
[10]Mehta RL,Kel lum JR,Shah SV,et al.Acute Kidrley Injury Network:report of an initiatire to improve outcomes in acute kidney injury[J].Crit Care,2007,11:R31.
[11]陈楠,张文,余海瑾,等.急性肾功能衰竭的流行病学研究[J].上海医学,2001,24(4)：239-242
[12]王丽.急性横纹肌溶解并发性肾功能衰竭的血液净化治疗[J].国外医学.移植与血液净化分册,2004,6(2)：21-23.
[13]郭伟.非创伤性横纹肌溶解致急性肾衰竭的血液净化治疗[J].中华急诊医学杂志,2002.11(1)：58-60.
[14]杨明浩,郝江,乌胜平.横纹肌溶解症并发急性肾功能衰竭的研究进展.解放军医学杂志,2006,6,31,212-216.
[15]Glycerol-induced acute renal failure in the rat [J].Am J Respir Crit Care Med,1997,156(4):1265-1269.
[16]Lochhead KM, Kharasch ED, Zager RA.Anesthetic effects on the glycerol model of rhabdomyolysis-induced acute renal failure in rats[J].J Am Soc Nephrol,1998,9 (2):305-309.
[17]Stefanovic V,Save V,Vlahovic P.et al.Reversal of experimental myoglobinuric acute renal failure with bioflavonoids from seeds of grape[J].Ren Fail.2000, 22(5):255-266.
[18]张训.侯凡凡主编.危重症肾脏病学.北京：人民卫生出版社,2009.2.
[19]喻业安,夏瑗瑜,张野.横纹肌溶解症导致急性肾衰竭的临床分析[J].中国血液净化杂志,2003,2(8)：443-444..
[20]Fernandeg WG,Hung O,Bruno R.Factors predicative of acute renal failure and need for hemodialysis among ED patients with rhabdomyolysis [J].Am J Emerg Med,2005,23(5):111-117.
[21]Bonventre JV,Weinberg JM.Recent Advance in the Pathophysiology of Ischemic Acute Renal Failure,J Am Nephrol,2003,14(8):2199-2210.
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