血浆置换抢救致死性药物过敏与毒物中毒的临床应用研究

Clinical Application Research of the Treatment of Fatal Drug Allergy and Poison Intoxication with Plasma Exchange

目的:探讨血浆置换在抢救致死性药物过敏、毒物中毒时作为常规治疗手段的可行性,并阐明其可能机制,为确立血浆置换在急救医学中的地位提供理论依据。方法:所有入选病例均通过深静脉穿刺置管建立临时血液通路,并行紧急血浆置换治疗。实验过程中监测治疗前后肿瘤坏死因子-α(TNF -α)、白介素- 6 (IL - 6 )、白介素- 8(IL - 8)、免疫球蛋白E(IgE)、补体3(C3 )及循环免疫复合物(CIC)水平。结果:4 9例不同药物过敏、毒物中毒患者存活4 5例。治疗后血浆TNF -α、IL - 8、IgE均有明显降低,而C3 则明显回升,并有统计学差异。治疗后CIC水平亦有下降,但无统计学差异。结论:血浆置换因其去除体内药物、毒物及炎症介质、免疫复合物的作用迅速,疗效确切并能稳定患者的免疫状态。可作为危重药物过敏、毒物中毒患者抢救的常规方法,并适用于在基层医院广泛开展。

Objective:To evaluate the feasibility of treatment of fatal drug allergy and poison intoxication with plasma exchange and eluciate its possible mechanism,which offered the theoretical basis for establishing the important status of plasma exchange in the emergency medicine.Methods:Temporary blood access were establishes by deep venipuncture for all patients,in which treated with plasma exchange immediately.In the course of experiment,we measured and compared the levels of tumor nocrosis factor-α(TNF-α),interleukin-6(IL-6),nterleukin-8(IL-8), immunoglobubin E(IgE), circulating immune complex(CIC) and C_3 in serum before and after the treatment.Results:All patients with fatal drug allergy or poison intoxication 45 patients were survival,markedly decreased levels of TNF-α,IL-8,IgE,markedly increased levels of C3were observed after treatment.Although the level of CIC was reduced after treatment,no difference was observed statistically.Conclusion:Plasma exchange can remove the drug,poison,CIC and inflammation mediator rapidly and effectively,which could be used as a routine treatment of critical drug allergy and poison intoxication and be suitable for being popularized in primary hospitals.