持續(xù)腎臟替代治療對創(chuàng)傷合并海水浸泡致急性腎衰竭犬的救治

摘要： 目的探討CRRT對創(chuàng)傷合并海水浸泡致急性腎衰竭(ARF)犬的救治效果。方法選擇海軍總醫(yī)院腎內(nèi)科成年雜種犬30只,致腹部開放傷后在19℃～21℃的人工海水中浸泡1.5h,隨機(jī)分為對照組(浸泡后不予處理),普通救治組(浸泡后給予一般急救)和CRRT組(浸泡后一般急救加CRRT),每組10只。檢測肛溫、平均動脈壓、腎功能、血氣分析、滲透壓、電解質(zhì)、TNF-α和IL-6等變化。結(jié)果①對照組出現(xiàn)典型的海戰(zhàn)傷傷情特點,表現(xiàn)為低體溫,低血壓,高滲,代謝性酸中毒;并且血肌酐、尿素氮、TNF-α和IL-6明顯升高(P<0.05)。②普通救治組犬的生存時間、肛溫、pH、HCO3-較對照組改善(P<0.05),但電解質(zhì)、滲透壓、腎功能、TNF-α和IL-6無變化。③CRRT組犬的生存時間明顯延長,各項指標(biāo)的改善均優(yōu)于對照組和普通救治組(P<0.01、P<0.05),病理改變也是最輕的。結(jié)論①一般急救措施救治后,犬發(fā)生ARF的幾率較對照組降低,生存時間有所延長,但大部分損傷指標(biāo)無明顯改善,病理提示腎臟損害嚴(yán)重,說明僅靠一般的急救是不夠的;②經(jīng)CRRT救治后,幾個主要的海戰(zhàn)傷傷情特點能夠得到有效救治,總體療效明顯好于普通救治組,病理改變也非常輕,表明CRRT對于戰(zhàn)傷合并海水浸泡導(dǎo)致的急性腎功能衰竭是一種非常有效的急救措施。
Objective To observe the different effect of early emergency treatment and continuous renal replacement therapy(CRRT) on the dog models of acute renal failure(ARF).Methods Thirty grown-up healthy dogs were randomly divided into three groups.All animals were subjected to open abdominal injury and a 1.5-hour-immersion in the 19℃～21℃ man-made seawater then immersion group won't be treated,emergency treatment group got emergency treatment after immersion;while the CRRT group took CRRT when the dogs turned better after the emergency treatment.Anus temperature mean arterial pressure、(MAP)、mOsm、pH、BUN、Scr、electrolyte、TNF-αand IL-6 were measured.Results ①The control group presented obvious hypotension,hypothermia,hypernatremia,hyperosmolality,hyperchloremia,acid-base imbalance and ARF and the TNF-α、IL-6 level raised up after seawater immersion(P < 0.05);② Compared with the immersion group,The emergency treatment group's survival time was longer and anus temperature、MAP、pH、HCO3-were improved(P < 0.05) except the electrolyte、mOsm、BUN、Scr、TNF-α and IL-6;③ The CRRT group'survival time was the longest and the conditions were obviously improved than other groups(P < 0.05),the kidney'pathologic changes of the CRRT group was the most slight of the three groups.Conclusion ① The incidence of ARF was lower after emergency treatment,and the conditions of the dogs turned better,but most dogs' hyperosmolality and acid-base imbalance didn't improved obviously,most of their BUN、Scr、TNF-α and IL-6 still raised up obviously,and the pathologic changes still showed aggravated injury.So it's indicated that the emergency treatment help but is not enough.② The dogs' hypothermia,hypernatremia,hyperosmolality,hyperchloremia,acid-base imbalance,ARF,and systemic inflammatory response syndrome(SIRS) obviously got better after CRRT than the other groups,and pathologic changes was slight.It's proved that CRRT can improve the conditions of the ARF dogs after trauma and seawater immersion and prolong the survival time.