群发性急性砷化氢中毒的救治

Treatment of patients with acute arsine poisoning

目的探究群发性急性砷化氢中毒的临床特点及治疗。方法采用单纯药物及血浆置换等不同方法对36例急性群发性砷化氢中毒患者进行治疗,观察其急性溶血、肝脏、肾脏、心脏酶学等动态变化,以及血、尿砷浓度的清除情况。结果急性砷化氢中毒临床表现明显的接触时间-效应关系,血砷与尿砷浓度呈显著线性相关(r=0．718,P=0．019)。但血砷、尿砷浓度与临床中毒程度无明显相关性,血砷、尿砷浓度与肌酸激酶(CK)、乳酸脱氢酶(LDH)、碱性磷酸酶(ALP)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、α-羟丁酸脱氢酶(HHBD)、间接胆红素(TBIL)、直接红素(DBIL)、尿素氮(BUN)、肌酐(Cr)等均无相关性(P＞0．05)；血浆置换治疗可快速控制溶血继续发生(24 h内溶血控制),缩短急性肾功能衰竭少尿期,同时血HBDH、AST、LDH、CK、IBIL、DBIL、BUN在治疗后12～72 h内快速下降(P＜0．05)。结论轻度急性砷化氢中毒单纯药物治疗预后良好,对急性重度砷化氢中毒血浆置换是治疗的有效手段之一,宜尽早使用。

Objective To study the characteristics of patients with acute arsine poisoning and its possible treatments, Methods The only use of drugs, or drugs with plasma exchange （PE） were used to treat 36 patients with acute arsine poisoning, The blood haemolysis, enzymes of creatine kinase （CK）, lactate dehydrogenase （LDH）, alkaline phosphatase （ALP）, alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, α-hydroxybutyric dehydrogenase （HHBD）, total bilirubin （TBIL）, indirect bilirubin （IBIL）, direct bilirubin （DBIL）, blood urea nitrogen （BUN）, serum creatinine （Cr） were observed, Results There was an exposure time-effect relation in clinical characteristics, and a linear correlation between the concentrations of arsenic in blood and urine （ r = 0,718, P = 0,019）, but no significant correlations were found between the concentrations of arsenic in blood or urine with CK, LDH, ALP, ALT, AST, HHBD, TBIL, IBIL, DBIL, BUN, Cr （P 〉 0.05）. In patients with severe acute arsine poisoning, PE quickly controlled hemolysis within 24 hours, and prevented secondary damage in kidney and other organs, oliguria stage got much shorter, and CK, LDH, ALP, AST, HHBD, TBIL, IBIL, BUN significantly reduced at 24 to 72 hours after PE treatment （P 〈 0.05）. Conclusions The only use of drug was enough for the treatment of mild acute arsine poisoning. To the patients with severe acute arsine poisoning, PE may be an effective method to control its blood hemolysis and prevent complications, which should be taken as early as possible.