战创伤及特殊作业环境相关急性肾损伤的防治
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摘要
急性肾损伤(AKI)是由各种病因引起的肾功能快速下降,是战创伤及特殊作业环境下的常见危重症。战创伤及特殊作业环境相关AKI具有发病率、病死率高,存活患者远期预后差等特殊性。该文介绍了战创伤及特殊作业环境相关AKI的病因、发病机制及主要分类,阐述了AKI的早期诊断、救治现状及存在的问题。同时,针对AKI基础研究不断深入,以及新型诊断标志物及肾脏替代治疗设备研究日益活跃的现状,为了适应未来战创伤及特殊作业环境相关AKI的救治需求,该文提出了相应的防治策略,并对未来该领域的发展趋势进行了展望。
Acute kidney injury(AKI) is a rapid decline in renal function caused by various etiologies,and is a common critical disease in combat and special working environment.The combat injury and special working environment-related AKI have the characteristics of high incidence and mortality,and the long-term prognosis of survival patients is poor.The present paper introduces the etiology,pathogenesis and main classification of AKI related to combat injury and special working environment,and expounds the present situation of early diagnosis and treatment of AKI and the existing problems.At present,the basic research on AKI is deepening,and the application of new diagnostic markers and renal replacement therapy equipment are becoming more and more active.In order to meet the treatment needs of AKI related to combat injury and special working environment in the future,this paper puts forward the corresponding prevention and treatment strategies,and looks forward to the development trend in this field in the future.
Acute kidney injury(AKI) is a rapid decline in renal function caused by various etiologies,and is a common critical disease in combat and special working environment.The combat injury and special working environment-related AKI have the characteristics of high incidence and mortality,and the long-term prognosis of survival patients is poor.The present paper introduces the etiology,pathogenesis and main classification of AKI related to combat injury and special working environment,and expounds the present situation of early diagnosis and treatment of AKI and the existing problems.At present,the basic research on AKI is deepening,and the application of new diagnostic markers and renal replacement therapy equipment are becoming more and more active.In order to meet the treatment needs of AKI related to combat injury and special working environment in the future,this paper puts forward the corresponding prevention and treatment strategies,and looks forward to the development trend in this field in the future.
引文
[1]Shashaty MG,Meyer NJ,Localio AR,et al.African American race,obesity,and blood product transfusion are risk factors for acute kidney injury in critically ill trauma patients[J].J Crit Care,2012,27(5):496-504.
[2]Beecher HK,Shapiro SL,Simeone FA,et al.The physiologic effects of wounds[D].Washington,DC:Office of the Surgeon General,Department of the Army,1952.
[3]Heung M,Steffick DE,Zivin K,et al.Acute kidney injury recovery pattern and subsequent risk of CKD:An analysis of veterans health administration data[J].Am J Kidney Dis,2016,67(5):742-752.
[4]Sun XF.Update in diagnosis and treatment of acute kidney injury[J].Trauma Crit Care Med,2013,1(1),25-28.[孙雪峰.急性肾损伤临床诊治研究进展[J].创伤与急危重病医学,2013,1(1),25-28.]
[5]Stewart IJ,Sosnov JA,Howard JT,et al.Retrospective analysis of long-term outcomes after combat injury:A hidden cost of war[J].Circulation,2015,132(22):2126-2133.
[6]Wang YD,Hong Q,LV Y,et al.Role of endoplasmic reticulum stress-induced apoptosis of renal tubular epithelial cells in rhabdomyolysisassociated acute kidney injury[J].Med J Chin PLA,2015,40(3):194-199.[王远大,洪权,吕杨,等.内质网应激途径诱导肾小管上皮细胞凋亡在横纹肌溶解肾损伤过程中的作用[J].解放军医学杂志,2015,40(3):194-199.]
[7]Heegard KD,Stewart IJ,Cap AP,et al.Early acute kidney injury in military casualties[J].J Trauma Acute Care Surg,2015,78(5):988-993.
[8]Stewart IJ,Sosnov JA,Howard JT,et al.Acute kidney injury in critically injured combat veterans:A retrospective cohort study[J].Am J Kidney Dis,2016,68(4):564-570.
[9]Stewart IJ,Tilley MA,Cotant CL,et al.Association of AKI with adverse outcomes in burned military casualties[J].Clin J Am Soc Nephrol,2012,7(2):199-206.
[10]Mesic E,Aleckovic-Halilovic M,Tulumovic D,et al.Nephrology in Bosnia and Herzegovina:impact of the 1992-95 war[J].Clin Kidney J,2018,11(6):803-809.
[11]He Q,Wang F,Li G,et al.Crush syndrome and acute kidney injury in the Wenchuan Earthquake[J].J Trauma,2011,70(5):1213-1217.
[12]Burdmann EA,Jha V.Acute kidney injury due to tropical infectious diseases and animal venoms:A tale of 2 continents[J].Kidney Int,2017,91(5):1033-1046.
[13]Smith J,Roberts B,Knight A,et al.A systematic literature review of the quality of evidence for injury and rehabilitation interventions in humanitarian crises[J].Int J Public Health,2015,60(7):865-872.
[14]Whelton A.Post-traumatic acute renal failure in Vietnam:a milestone in progress[J].Conn Med,1974,38(1):7-9.
[15]Smith LH Jr,Post RS,Teschan PE,et al.Post-traumatic renal insufficiency in military casualties.Ⅱ.Management,use of an artificial kidney,prognosis[J].Am J Med,1955,18(2):187-198.
[16]Bolanos JA,Yuan CM,Little DJ,et al.Outcomes after post-traumatic AKI requiring RRT in United States military service members[J].Clin JAm Soc Nephrol,2015,10(10):1732-1739.
[17]Gorbatkin C,Bass J,Finkelstein FO,et al.Peritoneal dialysis in austere environments:an emergent approach to renal failure management[J].West J Emerg Med,2018,19(3):548-556.
[18]Agar JW.Review:understanding sorbent dialysis systems[J].Nephrology(Carlton),2010,15(4):406-411.
[19]Wang Y,Pati S,Schreiber M.Cellular therapies and stem cell applications in trauma[J].Am J Surg,2018,215(5):963-972.
[20]Zonies D,DuBose J,Elterman J,et al.Early implementation of continuous renal replacement therapy optimizes casualty evacuation for combatrelated acute kidney injury[J].J Trauma Acute Care Surg,2013,75(2 Suppl 2):S210-S214.
[2]Beecher HK,Shapiro SL,Simeone FA,et al.The physiologic effects of wounds[D].Washington,DC:Office of the Surgeon General,Department of the Army,1952.
[3]Heung M,Steffick DE,Zivin K,et al.Acute kidney injury recovery pattern and subsequent risk of CKD:An analysis of veterans health administration data[J].Am J Kidney Dis,2016,67(5):742-752.
[4]Sun XF.Update in diagnosis and treatment of acute kidney injury[J].Trauma Crit Care Med,2013,1(1),25-28.[孙雪峰.急性肾损伤临床诊治研究进展[J].创伤与急危重病医学,2013,1(1),25-28.]
[5]Stewart IJ,Sosnov JA,Howard JT,et al.Retrospective analysis of long-term outcomes after combat injury:A hidden cost of war[J].Circulation,2015,132(22):2126-2133.
[6]Wang YD,Hong Q,LV Y,et al.Role of endoplasmic reticulum stress-induced apoptosis of renal tubular epithelial cells in rhabdomyolysisassociated acute kidney injury[J].Med J Chin PLA,2015,40(3):194-199.[王远大,洪权,吕杨,等.内质网应激途径诱导肾小管上皮细胞凋亡在横纹肌溶解肾损伤过程中的作用[J].解放军医学杂志,2015,40(3):194-199.]
[7]Heegard KD,Stewart IJ,Cap AP,et al.Early acute kidney injury in military casualties[J].J Trauma Acute Care Surg,2015,78(5):988-993.
[8]Stewart IJ,Sosnov JA,Howard JT,et al.Acute kidney injury in critically injured combat veterans:A retrospective cohort study[J].Am J Kidney Dis,2016,68(4):564-570.
[9]Stewart IJ,Tilley MA,Cotant CL,et al.Association of AKI with adverse outcomes in burned military casualties[J].Clin J Am Soc Nephrol,2012,7(2):199-206.
[10]Mesic E,Aleckovic-Halilovic M,Tulumovic D,et al.Nephrology in Bosnia and Herzegovina:impact of the 1992-95 war[J].Clin Kidney J,2018,11(6):803-809.
[11]He Q,Wang F,Li G,et al.Crush syndrome and acute kidney injury in the Wenchuan Earthquake[J].J Trauma,2011,70(5):1213-1217.
[12]Burdmann EA,Jha V.Acute kidney injury due to tropical infectious diseases and animal venoms:A tale of 2 continents[J].Kidney Int,2017,91(5):1033-1046.
[13]Smith J,Roberts B,Knight A,et al.A systematic literature review of the quality of evidence for injury and rehabilitation interventions in humanitarian crises[J].Int J Public Health,2015,60(7):865-872.
[14]Whelton A.Post-traumatic acute renal failure in Vietnam:a milestone in progress[J].Conn Med,1974,38(1):7-9.
[15]Smith LH Jr,Post RS,Teschan PE,et al.Post-traumatic renal insufficiency in military casualties.Ⅱ.Management,use of an artificial kidney,prognosis[J].Am J Med,1955,18(2):187-198.
[16]Bolanos JA,Yuan CM,Little DJ,et al.Outcomes after post-traumatic AKI requiring RRT in United States military service members[J].Clin JAm Soc Nephrol,2015,10(10):1732-1739.
[17]Gorbatkin C,Bass J,Finkelstein FO,et al.Peritoneal dialysis in austere environments:an emergent approach to renal failure management[J].West J Emerg Med,2018,19(3):548-556.
[18]Agar JW.Review:understanding sorbent dialysis systems[J].Nephrology(Carlton),2010,15(4):406-411.
[19]Wang Y,Pati S,Schreiber M.Cellular therapies and stem cell applications in trauma[J].Am J Surg,2018,215(5):963-972.
[20]Zonies D,DuBose J,Elterman J,et al.Early implementation of continuous renal replacement therapy optimizes casualty evacuation for combatrelated acute kidney injury[J].J Trauma Acute Care Surg,2013,75(2 Suppl 2):S210-S214.