An evaluation of therapeutic effect of continuous renal replacement therapy for treatment of patients with heat stroke complicated by multiple organ dysfunction syndrome / 中国中西医结合急救杂志

ABSTRACT

Objective To investigate the value and efficacy of continuous renal replacement therapy(CRRT) for treatment of heat stroke patients complicated by multiple organ dysfunction syndrome(MODS). Methods The clinical data of 19 heat stroke patients complicated by MODS admitted into the hospital in a period from July 15,2010 to August 30,2010 and treated by CRRT were analyzed retrospectively. Continuous venovenous hemofiltation(CVVH) mode was used in all patients and the initial temperature of replacement fluid range was 28℃to 32℃persisting in 2.0 to 2.5 hours and afterward it maintained at 36℃. Prognosis and adverse effect were observed,the patients' body temperature,heart rate(HR),mean arterial pressure(MAP),acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores,oxygenation index(PaO2/FiO2),the levels of serum urea nitrogen(BUN),serum creatinine(SCr), myoglobin(Mb),creatine kinase(CK),alanine aminotransferase(ALT),aspartate aminotransferase(AST)and arterial lactate(Lac)were monitored before and after CRRT treatment. Results Fifteen patients were cured or improved,and 4 died. Compared with those before CRRT treatment,body temperature(℃),HR(bmp),MAP(mm Hg,1 mm Hg=0.133 kPa),APACHEⅡevaluation(score),PaO2/FiO2(mm Hg)were significantly improved(body temperature36.8±0.2 vs. 41.6±0.3,HR93.6±10.3 vs. 132.5±11.4,MAP69.8±9.9 vs. 45.2±7.7,APACHEⅡ12.3±3.9 vs. 29.6±4.6,PaO2/FiO2213.6±95.4 vs. 126.5±87.4,all P<0.05);the levels of BUN(mmol/L),SCr(μmol/L), Mb(μg/L),CK(U/L),ALT(U/L),AST(U/L),Lac(mmol/L)were significantly reduced after the treatment(BUN23.9±5.3 vs. 42.6±5.4,SCr123±47 vs. 356±51,Mb201±45 vs. 468±39,CK217±32 vs. 843±41,ALT79±36 vs. 894±88,AST57±28 vs. 867±92,Lac3.5±2.4 vs. 16.6±3.9,all P<0.05). In the process of the treatment,hemodynamics was stable,and no obvious side effects occurred. Conclusion CRRT treatment can exactly and safely reduce the core body temperature of patients with heat stroke,and it can also effectively eliminate metabolites of BUN,Cr,Mb,etc,ameliorate the inflammatory reaction and supporting the functions of liver,kidneys and other vital organs,thus the treatment is also safe and effective for such patients complicated by MODS.