摘要
目的分析4例严重烧伤患者并发早期急性肾损伤(AKI)的原因并探讨相关治疗方法。方法回顾性分析2014年6月-2017年12月暨南大学医学院附属广州红十字会医院(下称笔者单位)收治的4例严重烧伤并发早期AKI患者的临床资料。患者均为男性,年龄为23~33(30±5)岁,烧伤深度深Ⅱ~Ⅲ度,并发四肢肌筋膜室综合征和不同程度的横纹肌损伤,均经外院治疗后转入笔者单位。将患者按烧伤总面积从小到大编号,1、2、3、4号患者烧伤总面积分别为10%、80%、90%、95%体表总面积,并发早期AKI时间分别为伤后48、11、29、48 h,转入笔者单位时间分别为伤后60、11、29、144 h。2、3号患者转入院时已出现低血容量性休克。4例患者转入院后均行连续性肾脏替代治疗(CRRT),在血流动力学监测和器官功能监护的支持下,积极对并发肌筋膜室综合征的四肢行切开、彻底减压探查,清除已坏死的肌肉组织或行截肢术。对四肢焦痂切开减压后创面,采用桀亚敷料皮或猪皮临时覆盖、多次清创并结合负压封闭引流治疗形成新鲜肉芽创面后,和其他分期切削痂创面,分别用自体皮行Meek植皮及微粒皮、网状皮、小皮片移植等覆盖。记录患者治疗结局,行CRRT时间,手术次数,血肌酐、肌红蛋白恢复正常时间,住院时间及随访情况。结果本组4例患者转入笔者单位后均治愈,其中1、4号患者共5个患肢因并发肌筋膜室综合征并有大量肌肉坏死无法保留,行截肢术。1、2 3 4号患者分别行19、35、14、25 d CRRT,行5、6、10、8次手术,于转入院后22、35、37、48 d血肌酐恢复正常,于转入院后18、28、25、30 d血肌红蛋白恢复正常,于住院52、105、148、156 d创面基本愈合后出院。随访1~36个月,4例患者肾功能均元异常。结论1、4号患者早期AKI由严重烧伤并发肌筋膜室综合征导致横纹肌溶解所致,另2例还与低血容量性休克、肾灌注不足有关。�
Objective To analyze the causes of complication of early acute kidney injury (AKI)in four severely burned patients,and to explore the related treatment methods.Methods The clinical data of 4 patients with severe burn complicated with early AKI admitted to Guangzhou Red Cross Hospital Affiliated to Medical College of Jinan University (hereinafter referred to as our hospital)from June 2014 to December 2017 were retrospectively analyzed.All the patients were male,aged 23 -33 (30±5)years old,with depth of burns ranged from deep partial-thickness to full-thickness,complicated with myofascial compartment syndrome of extremities and varying degrees of striated muscle injury,and treated in other hospitals before transfer to our hospital.The patients were numbered from small to large according to the total burn area.The total burn area of patients No.1,2,3,and 4 was 10%,80%,90%,and 95%total body surface area respectively,their occurrence time of early AKI was 48,11,29,and 48 hours after injury respectively,and their time of arriving our hospital was 60,11,29,and 144 hours after injury respectively.Hypovolemic shock occurred in patients No.2 and 3 at admission to our hospital.All the patients received continuous renal replacement therapy (CRRT)after admission to our hospital.Under the support of hemodynamic monitoring and organ function monitoring,the limbs complicated with myofaseial compartment syndrome were incised,thorough decompression exploration was performed,and necrotic muscle tissue was removed or amputation was performed.After eseharectomy and decompression of limbs,fresh granulation wounds were formed by temporarily covering wounds with Jieya dressing skin or pig skin,multiple debridements,and vacuum sealing drainage.Fresh granulation wounds and other wounds underwent staged eschar excision and shaving were covered with autologous Meek skin graft,particulate skin graft,reticular,skin graft and small skin graft respectively.The treatment outcome,CRRT time,operation times,time of recovery of serum creatinine and
作者
陈宾
况芳
李孝建
张志
邓忠远
张旭辉
张涛
钟晓旻
汤文彬
刘昌玲
Chen Bin;Kuang Fang;Li Xiaojian;Zhang Zhi;Deng Zhongyuan;Zhang Xuhui;Zhang Tao;Zhong Xiaomin;Tang Wenbin;Liu Changling(Department of Burns and Plastic Surgery,Guangzhou Red Cross Hospital,Medical College,Jinan University,Guangzhou 510220,China;Department of Critical Care Medicine,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhoa 510000,China)
出处
《中华烧伤杂志》
CAS
CSCD
北大核心
2019年第2期110-115,共6页
Chinese Journal of Burns
基金
广州市科技计划(2014Y2-00091、201508020262).
