重症毒鼠强中毒两种血液净化治疗疗效比较

Sequential blood purification in treatment of severe tetramine poisoning

目的探讨序贯性血液灌流(Hemoperfusion,HP)与连续性静脉-静脉血液滤过(Continuous venovenous hemofiltration,CVVH)治疗重症毒鼠强中毒患者的临床疗效和对预后的影响。方法44例重症毒鼠强中毒的患者入院后随机分为两组。在常规治疗的基础上,接受序贯性HP+CVVH治疗的22例为治疗组,接受单纯HP治疗的22例为对照组,观察两组昏迷至清醒时间、抽搐完全停止时间、治愈率及病死率。结果治疗组恢复清醒时间、抽搐完全停止时间与对照组比较明显减少(P<0.05),治愈率提高(P<0.05),病死率降低(P<0.05)。较早治疗患者痊愈率显著高于晚期治疗患者(91.7%vs60%,P<0.05)。结论序贯性HP+CVVH治疗重症毒鼠强中毒优于单用HP治疗,能有效缓解临床症状,提高抢救成功率,降低病死率,可明显改善毒鼠强中毒患者的预后,但血液净化治疗须尽早进行。

Objective To investigate the therapeutic effect of sequential hemoperfusion （HP） and continuous venovenous hemo-filtration（CVVH） and its impact on outcome in treatment of patients with severe tetramine poisoning. Methods Forty - four patients with severe tetramine poisoning were randomly divided into thereapeutic group and control group. Besides routine medical therapy, 22 patients in the treatment group were treated with HP and CVVH. 22 patients in the control group were treated with HP alone. The data of hours of persisting coma, time of convulsion complete cessation, cure rate and fatality rate were collected. Results The hours persisting from coma to awaking and the time of convulsion complete cessation were significantly shorter in the treatment group than those in the control group（P 〈 0. 05 ）. Recovery rate in the treatment group was higher than that in the control group , for patients with complete recovery ,hours of persisting coma after the initation of HP and CVVH were fewer in the early initiation group than those in the later initiation group （91.7% vs 60% , P 〈 0.05 ）. Conclusions Sequential hemoperfusion and continuous venovenous hemofiltration are effective for severe poisoning patients. Early initiation of sequential HP and CVVH treatment greatly improves the outcome of severe tetramine poisoned patients.