CRRT在地震CS患者肌肉损伤和肾功能衰竭中的诊断评估
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摘要
目的对被地震垮塌物埋压超过100小时的15例挤压综合征(Crush Syndrome CS)伤者血清中心肌标志物和胱抑素C浓度进行检测,并运用连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)进行疗效评估。方法使用BECKMAN-LX20全自动生化分析仪,检测由地震所致的CS伤员接受CRRT疗法后血清中CK、CK-MB、Tnl、Myo和胱抑素C的浓度。结果CS伤员的CK、CK-MB、Tnl、Myo、胱抑素C水平明显增高,与正常对照组比较有显著性差异(P<0.05),有统计学意义。经过CRRT治疗一段时间后,CK、CK-MB、Tnl、Myo、胱抑素C水平有所下降,部分处于正常水平。结论CK、CK-MB、Tnl、Myo是肌肉损伤的标志物,而胱抑素C是目前临床判断肾脏功能的一个重要指标,了解地震伤员特别是CS伤员的CK、CK-MB、Tnl、Myo、胱抑素C变化,为临床救治、病情监控及疗效评估等提供依据。
Objective 15 Crush Syndrome patients that intered over 100 hours by earthquake fall objects tested the Cardiac Muscle Sign Substance and Cystatin-C level,use CRRT scheme to evaluate the curative effect.Methods Use BECKMAN-LX20 auto-biochemical apparatus to test Crush Syndrome patient's CK、CK-MB、Tnl、Myo and Cystatin-C level;Results The Crush Syndrome patient's CK、CK-MB、Tnl、Myo and Cystatin-C level raise fleetly.It is observably difference that Crush Syndrome patients compare with normal people(P<0.05).By period of time in CRRT,the CK、CK-MB、Tnl、Myo and Cystatin-C level was fall and a part was natural.Conclusion CK、CK-MB、Tnl、Myo are very important Sign Substance in muscle damnification and Cystatin-C is a important guide line that judged kidney function for clinic.For understand The Crush Syndrome patient's Cystatin-C level change,it can provide important gist such as clinic cure、state of an illness control、curative effect evaluate and so on.
Objective 15 Crush Syndrome patients that intered over 100 hours by earthquake fall objects tested the Cardiac Muscle Sign Substance and Cystatin-C level,use CRRT scheme to evaluate the curative effect.Methods Use BECKMAN-LX20 auto-biochemical apparatus to test Crush Syndrome patient's CK、CK-MB、Tnl、Myo and Cystatin-C level;Results The Crush Syndrome patient's CK、CK-MB、Tnl、Myo and Cystatin-C level raise fleetly.It is observably difference that Crush Syndrome patients compare with normal people(P<0.05).By period of time in CRRT,the CK、CK-MB、Tnl、Myo and Cystatin-C level was fall and a part was natural.Conclusion CK、CK-MB、Tnl、Myo are very important Sign Substance in muscle damnification and Cystatin-C is a important guide line that judged kidney function for clinic.For understand The Crush Syndrome patient's Cystatin-C level change,it can provide important gist such as clinic cure、state of an illness control、curative effect evaluate and so on.
引文
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[9]Uta Kerkweg,Daniel Schmitz,Herbert de Groot.Screening for the Formationof Reactive Oxygen Species and of NO in Muscle Tissue and Remote Organsupon Mechanical Trauma to the Mouse Hind Limb[J].Eur Surg Res,2006;38:83.
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[11]Erek E,Sever MS,Serdenge ti K,et al.An overview of morbidity and mor-tality in patients with acute renal failure due to crush syndrome:the Mar-mara earthquake experience[J].Nephrol Dial Transplant,2002,17:33.
[12]Anastasi A,Brown MA,Kembbavi AA,et al.Cystatin,a protein inhibitorof cysteine proteinases.Improved purification from egg white,characteriza-tion,and detection in chicken serum[J].Biochem J,1983,211:129.
[13]WoitasRP,StoffeL-WagnerB,FlommersfeldS,et al.Correlationofs-erumconcentrations of cystatin Candcreatinine to inuli ntoinulincle aran-ceinlinercinhosis[J].ClinChem,2000,46(5):711.
[14]StbucB,VrhonecL,Stabuc-SilihM,et al.I mprovedpredictionofdecreased-creatinineclearancebyserumcystatin C:Useincancerpatientsbeforeanddringchemotherapy[J].ClinChem,2000,46(2):193.
[2]鲁天瑜,竟花兰.挤压综合征的法医学研究进展[J].中国法医学杂志,2006,21(4):226.
[3]Malinoski DJ,Slater MS,Mullins RJ.Crush injury and rhabdomyolysis[J].Crit Care Clin,2004,20(1):171.
[4]Shigemoto T,Rinka H,Matsuo Y,et al.Blood purifica tion for crush syn-drome[J].Renal Failure,1997,19:711.
[5]Ji DX,Gong DH,Xie HL,et al.A retrospective study of continuous renalreplacement therapy versus intermittent hemodialysis in severe acute renalfailure[J].Chin Med J,2001,114:1157.
[6]冯利平,张玲.连续性血液净化在重症急性胰腺炎的治疗前景[J].国际移植与血液净化杂志,2006,4(1):11.
[7]M.S.Sever,E.Erek,R.Vanholder,et al.Serum potassium in the crushsyndrome victims of the Marmara disaster[J].Clinical Nephrology,2003,59(5):326.
[8]Cüneyt Ensari,Oma Tüfek ioglu,Deniz Ayli,et al.Response to DelayedFluid Therapy in Crush Syndrome[J].Nephron J,2002,92:941.
[9]Uta Kerkweg,Daniel Schmitz,Herbert de Groot.Screening for the Formationof Reactive Oxygen Species and of NO in Muscle Tissue and Remote Organsupon Mechanical Trauma to the Mouse Hind Limb[J].Eur Surg Res,2006;38:83.
[10]O Demirkiran,Y Dikmen,T Utku,et al.Crush syndrome patients after theMarmara earthquake[J].Emerg.Med.J,2003,20:247.
[11]Erek E,Sever MS,Serdenge ti K,et al.An overview of morbidity and mor-tality in patients with acute renal failure due to crush syndrome:the Mar-mara earthquake experience[J].Nephrol Dial Transplant,2002,17:33.
[12]Anastasi A,Brown MA,Kembbavi AA,et al.Cystatin,a protein inhibitorof cysteine proteinases.Improved purification from egg white,characteriza-tion,and detection in chicken serum[J].Biochem J,1983,211:129.
[13]WoitasRP,StoffeL-WagnerB,FlommersfeldS,et al.Correlationofs-erumconcentrations of cystatin Candcreatinine to inuli ntoinulincle aran-ceinlinercinhosis[J].ClinChem,2000,46(5):711.
[14]StbucB,VrhonecL,Stabuc-SilihM,et al.I mprovedpredictionofdecreased-creatinineclearancebyserumcystatin C:Useincancerpatientsbeforeanddringchemotherapy[J].ClinChem,2000,46(2):193.
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