Clinical Observation And Analysis Of Continuous Blood Purification In The Treatment Of Severe Burn Complicated With Hypernatremia

Objective:To compare the clinical efficacy of continuous blood purification therapy and conventional medical method in the treatment of severe burn complicated with hypernatremia,and to explore the therapeutic effect of continuous blood purification on patients with severe burn complicated with hypernatremia.Methods:The clinical data of 28 patients with severe burn complicated with hypernatremia treated in burn intensive care unit(Burn Intensive Care Unit,BICU)of the first affiliated Hospital of Nanchang University from May 2014 to May 2018 were analyzed retrospectively.Among them,13 cases were treated with continuous blood purification,15 cases were treated with routine medical treatment,and divided into blood purification group(CBP group,n = 13)and routine treatment group(),CBP group,n = 15).The changes of vital signs were observed when hypernatremia occurred in the two groups and after 24 h and 48 h of treatment.Mean arterial pressure(MAP),arterial partial pressure of oxygen(PaO2),serum sodium ion(Na+),blood urea nitrogen(BUN),serum creatinine(Scr),blood glucose(Glu),Blood lactic acid(Lac),peripheral blood leukocyte count(WBC),serum procalcitonin(PCT),The changes of laboratory indexes such as C-reactive protein(CRP)and the prognosis of the patients.The clinical therapeutic effects of the two groups were evaluated and analyzed.Results:1.After blood purification,all the observed indexes in CBP group were improved,the mean arterial pressure and arterial partial pressure of oxygen were significantly increased(P < 0.05),the heart rate and respiratory frequency were decreased,and the body temperature was gradually decreased.Blood sodium,blood urea nitrogen,serum creatinine,blood glucose,blood lactic acid,white blood cell,blood calcitonin and C-reactive protein were significantly decreased.With the prolongation oftreatment time,serum sodium decreased gradually,and there was significant difference between before and after treatment [(160.2 ±8.1)mmoL/L:(146.4 ±2.3)mmoL/L].There was significant difference in the observation indexes before and after treatment in CBP group(P < 0.05).2.After treatment,the vital signs,blood sodium,blood urea nitrogen,serum creatinine,blood glucose and blood lactic acid in the routine treatment group were improved compared with those before treatment,but the difference was not statistically significant(P > 0.05).3.There were significant differences in blood sodium,blood urea nitrogen,serum creatinine,arterial partial pressure of oxygen,blood lactic acid,white blood cell,serum calcitonin and C-reactive protein between CBP group and routine treatment group(P < 0.05).4.There were 8 deaths in CBP group and 10 deaths in routine treatment group.the causes of death were cerebral hernia,respiratory failure and multiple organ failure caused by septic shock.there was no significant difference in mortality between CBP group and control group(P > 0.05).There were no obvious adverse reactions in the course of CBP treatment.Conclusion:Continuous blood purification can effectively reduce the serum sodium concentration in patients with severe burn complicated with hypernatremia,which is one of the important auxiliary treatment measures to correct severe electrolyte disturbance and maintain acid-base balance,and the hemodynamics is stable during the treatment.Continuous blood purification is more effective than single routine therapy in the treatment of hypernatremia caused by severe burn,but it is difficult to determine the prognosis of severe burn patients complicated with severe hypernatremia.