Nakamura Kensuke, Inokuchi Ryota, Hiruma Takahiro, Omura Takaki, Ohshima Kazuma, Tokunaga Kurato, Ueda Atsushi, Doi Kent
Department of Emergency and Critical Care Medicine Hitachi General Hospital Ibaraki Japan.
Department of Emergency and General Medicine JR General Hospital Tokyo Japan.
Acute Med Surg. 2015 Nov 29;3(3):260-264. doi: 10.1002/ams2.170. eCollection 2016 Jul.
A 51-year-old man presented with severe burns, with a burn index of 33.5. Relaxation incisions were made in the trunk and right arm. Ringer's solution (12,000 mL) was used as initial fluid therapy for the first 24 h. The patient's serum Na level gradually increased to 170 mEq/L; infusion was carried out to correct the hypernatremia. Continuous veno-venous hemodialysis and filtration succeeded in maintaining the serum Na level at approximately 145 mEq/L.
After the initiation of continuous veno-venous hemodialysis and filtration, the skin graft survival rate improved markedly with the normalization of the Na level, and the patient recovered smoothly. He was discharged on foot.
Hypernatremia, frequently observed in patients with extensive burns, is considered to be markedly disadvantageous for the survival of skin grafts. Continuous veno-venous hemodialysis and filtration may be one of the options for the treatment of refractory hypernatremia in severe burns.
一名51岁男性因严重烧伤入院，烧伤指数为33.5。在其躯干和右臂进行了切开减张术。在前24小时，使用林格氏液（12000毫升）作为初始液体疗法。患者血清钠水平逐渐升至170毫当量/升；通过输液纠正高钠血症。连续性静脉-静脉血液透析滤过成功地将血清钠水平维持在约145毫当量/升。
开始连续性静脉-静脉血液透析滤过后，随着钠水平恢复正常，皮肤移植成活率显著提高，患者顺利康复。他步行出院。
大面积烧伤患者中常见的高钠血症被认为对皮肤移植存活极为不利。连续性静脉-静脉血液透析滤过可能是治疗严重烧伤顽固性高钠血症的选择之一。
