简易血浆置换-血液滤过序贯救治重症毒蘑菇中毒的疗效观察

Clinical Effect Observation of Simple Plasma Exchange-Sequential Hemofiltration for Treatment of Severe Poisonous Mushroom Poisoning

目的讨论研究简易血浆置换-血液滤过序贯用于救治重症毒蘑菇中毒及肝、肾等多脏器功能损伤的临床疗效与价值及提高急性中毒救治的成功率。方法选取我院重症毒蘑菇中毒合并肝、肾及血液系统受损患者60例。随机分组为置换组与药物组。置换组对30例患者建立体外循环并行一次性血浆置换,之后进行血液滤过并配合其他药物进行补液、利尿及碱化尿液、输注洗涤红细胞等治疗;药物组进行针对性药物治疗。观察治疗前后患者各脏器功能指标变化、症状缓解情况及治疗总有效率等指标。结果治疗后置换组治疗总有效率为100%显著优于药物组80%。且经过治疗后,置换组发生不适症状者有恶心2例,呕吐1例,剧烈腹泻1例,乏力1例,无昏迷病例,药物组发生不适症状者有恶心5例,呕吐4例,剧烈腹泻4例,乏力4例,无昏迷病例且两组治疗前后比较各脏器功能指标如肌酸激酶、肌酸激酶同工酶、谷草转氨酶、谷丙转氨酶、血清肌酐及尿素氮,置换组各值为(91±11)、(99±52)、(87±21)、(211±112)、(137±49)及(13±4),药物组各值为(27±6)、(55±9)、(31±16)、(109±71)、(76±49)及(7±3),由此可知,经过置换组不适症状发生人数显著少于药物组人数且置换组心、肝、肾功能检查指标显著优于药物组指标(P<0.05)。结论使用简易血浆置换-血液滤过序贯对救治重症毒蘑菇中毒及多系统功能损伤患者疗效显著。值得推广。

Objective To discuss and study the clinical effect of simple plasma exchange-sequential hemofiltration for treatment of severe poisonous mushroom poisoning and function damages of multiple organs like liver and kidney and to improve treatment success rate of acute poisoning. Methods 10 patients with severe poisonous mushroom poisoning combined damages of liver, kidney and blood system were chosen. They were randomly divided into exchange group and medication group. 5 cases of exchange group were given establishment of extracorporeal circulation and underwent one-time plasma exchange, then they were given hemofiltration combined with other medication for fluid infusion, diuresis, alkalizing urine and infusing and washing red blood cells; medication group was given targeted drug therapy. Before and after treatment, changes of indicators of organ function, symptom relieving conditions and total effective rates of the 2 groups were observed. Results After treatment, the treatment group replaced 100% of the total effective rate was significantly better than 80% of the drug group. And after treatment, symptoms occur replacement group were two cases of nausea, vomiting, one case, one case of severe diarrhea, fatigue one case, no coma patients, the drug group were nausea symptoms occurred in 5 cases, 4 cases of vomiting, severe diarrhea four cases, fatigue four cases, coma patients and no comparison of the two groups before and after treatment of organ function indicators such as creatine kinase, creatine kinase, aspartate aminotransferase, alanine aminotransferase, serum creatinine and blood urea nitrogen, the values replacement group of（91±11）,（99±52）,（87±21）,（211±112）,（137±49） and（13±4）, each group of drugs is（27±6）,（55±9）,（31±16）,（109± 71）,（76±49） and（7±3）, can be seen through the replacement group of symptoms occurred significantly less than the number of groups and the number of drug substitution group heart, liver and kidney function tests were significantly better than the drug group index（P〈0.05） Conclusion Simple plasma exchange-sequential hemofiltration has a significant clinical effect for treatment of patients with severe poisonous mushroom poisoning and function damages of multiple organs, so it is worth of being popularized.