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目的:探讨烧伤合并急性肾功能衰竭(ARF)的早期指标检测以及各种危险因素。方法:选择本院2008年1月～2009年6月收治的75例中重度热烧伤患者,Ⅱ度或Ⅲ度烧伤面积累计20%-70%TBSA。所有患者在人院时、入院后3d、7d、14d和21d检测血清肌酐(Scr)、血尿素氮(BUN)、尿微量白蛋白(mALB)和滤过钠排泄分数(FeNa)。结果:75例烧伤患者中有14例(18.7%)并发ARF,其中10例进行了血液净化治疗。烧伤合并ARF组烧伤面积和脓毒症发生率均明显高于烧伤未合并ARF组(P均<0.05)。烧伤合并ARF组Scr和BUN水平分别在住院7d和14d后明显高于烧伤未合并ARF组(P均<0.05)。烧伤合并ARF组入院时mALB水平已达到正常值3-4倍,21d时达到最大值,在观察期间一直高于烧伤未合并ARF组(P均<0.05)。烧伤合并ARF组滤过钠排泄分数均大于2%。烧伤面积与脓毒症是烧伤后ARF发生的主要危险因素(复相关系数R分别为0.52和0.23,P均<0.05)。结论:烧伤合并ARF与烧伤面积与脓毒症相关,mALB是早期监测ARF的有用指标。
Objective: To investigate the early detection of ARF and various risk factors in burn patients. Methods: From January 2008 to June 2009 in our hospital, 75 patients with moderate to severe thermal injury were enrolled. Twenty-one to 70% TBSA of grade Ⅱ or Ⅲ degree burn area was accumulated. Serum creatinine (Scr), blood urea nitrogen (BUN), urinary microalbumin (MALB) and filtration rate of sodium excretion (FeNa) were detected in all the patients at the time of admission, 3d, 7d, 14d and 21d after admission. Results: Fourteen of 75 (18.7%) burn patients were complicated with ARF, of which 10 were treated with blood purification. The burn area and sepsis rate in burns combined ARF group were significantly higher than those in burns without ARF group (all P <0.05). The levels of Scr and BUN in burn combined with ARF group were significantly higher than those in burn group without ARF after 7 and 14 days of hospitalization (all P <0.05). The level of mALB in patients with burns and ARF admission was 3-4 times of normal and reached the maximum at 21 days, which was always higher than that of burn without ARF during the observation period (all P <0.05). The fraction of sodium excreted by burn combined with ARF was more than 2%. Burn area and sepsis were the main risk factors of ARF after burns (the correlation coefficients R were 0.52 and 0.23, P <0.05 respectively). CONCLUSIONS: Burns associated with ARF and burn area are associated with sepsis, and mALB is a useful indicator of early monitoring of ARF.