目的探讨床旁血液净化在危重烧伤患者中的应用。方法回顾分析我院血液净化中心2005年～2009年应用床旁血液净化方法,对20例伴有急性肾功能衰竭(ARF)的危重烧伤患者实行间断性CRRT治疗的资料。患者平均年龄42.2岁±10岁,平均烧伤面积为63.8%TBSA±13.7%TBSA;所有患者都需要机械式呼吸支持,大部分患者并发脓毒症,甚至是多器官功能障碍综合征(MODS),平均ARF出现的时间是10.8d±9d。20例患者均与脓毒症相关,其中:低血压14例,需用血管加压药者6例;4例患者属于非少尿型肾功能衰竭。接受CRRT治疗的主要原因包括:氮血症(20/20)、液体过载(12/20)、高钾血症(6/20)、高钠血症(18/20)和/或酸中毒(2/20)。使用Prisma系统Muhiflow-100滤器、前稀释,先后行100余次CRRT治疗(包括病情平稳后接受间断性滤过透析治疗)。14例患者使用了肝素1.25mg/h～5.00mg/h,6例患者未用抗凝剂。患者在刚收进烧伤科时,血清尿素氮和肌酐浓度分别为7.1mmol/L±2.3mmol/L和116.1μmol/L±38.2μmol/L,当CRRT治疗开始时,血清尿素氮和肌酐浓度已上升至34.8mmol/L±9.2mmol/L和398.24μmol/L±286.3μmol/L。16例患者同时接受肠内和肠外营养支持,4例患者只接受肠外营养支持。结果 8例生还者肾功能全都恢复正常,在出院时,血清肌酐浓度是80.1μmol/L±11.1μmol/L。在CRRT治疗期间,20例患者均没有发生明显并发症。结论 CRRT有如下优势:(1)维持体内水、电解质和酸碱平衡,有效地保证了内环境的稳定;(2)保证营养支持及其它药物治疗的实施;(3)对血流动力学影响很小,且在低血压时也可应用;(4)对发热患者还可以起到降温作用;(5)有效地清除毒素并降低氧耗。连续性血液净化是抢救危重烧伤患者的重要治疗手段之一,虽然危重患者病死率高,但是它能够延长危重患者的生命却是公认的。功能上由替代转化为支持,是一种概念上的突破。随着血液净化技术的不断完善,它将成为危重病医学的发展趋势。 Objective To explore the application of bedside blood purification in patients with critical burn. Methods A retrospective analysis of our hospital blood purification center from 2005 to 2009, application of bedside blood purification method for the treatment of 20 cases of severe acute burn patients with acute renal failure (ARF) intermittent CRRT treatment data. The mean age of patients was 42.2 years ± 10 years and the average burn area was 63.8% TBSA ± 13.7%. All patients required mechanical respiratory support, most had sepsis and even multiple organ dysfunction syndrome (MODS) The average ARF time is 10.8d ± 9d. Twenty patients were all associated with sepsis, including 14 with hypotension and 6 with vasopressors, and 4 with non-oliguric renal failure. The main causes of CRRT treatment include azotemia (20/20), fluid overload (12/20), hyperkalemia (6/20), hypernatremia (18/20) and / or acidosis 2/20). Prisma system using Muhiflow-100 filter, before dilution, followed by more than 100 CRRT treatment (including stable disease after receiving intermittent filtration dialysis treatment). 14 patients used heparin 1.25mg / h ~ 5.00mg / h, 6 patients without anticoagulant. The level of serum urea nitrogen and creatinine was 7.1 mmol / L ± 2.3 mmol / L and 116.1 μmol / L ± 38.2 μmol / L, respectively. When the CRRT treatment started, the serum urea nitrogen and creatinine concentration had been To 34.8 mmol / L ± 9.2 mmol / L and 398.24 μmol / L ± 286.3 μmol / L. Sixteen patients received both enteral and parenteral nutrition support and four patients received parenteral nutrition support alone. Results All 8 survivors recovered to normal renal function. At discharge, serum creatinine concentration was 80.1 μmol / L ± 11.1 μmol / L. None of the 20 patients experienced any significant complication during CRRT. Conclusions CRRT has the following advantages: (1) Maintaining water, electrolytes and acid-base balance in the body effectively stabilizes the internal environment; (2) Ensuring nutritional support and other medical treatments; (3) Effects on hemodynamics Small, and can also be used in hypotension; (4) can also have a cooling effect on fever patients; (5) effectively remove toxins and reduce oxygen consumption. Continuous blood purification is one of the important treatments for rescue of critically ill burn patients. Although critically ill patients have a high case fatality rate, it is recognized that it can prolong the lives of critically ill patients. Functionally from alternative to support, is a conceptual breakthrough. With the continuous improvement of blood purification technology, it will become the development trend of critical illness medicine.