三种血液净化方式联合治疗20例急性砷化氢中毒疗效观察

Effect of a therapy combining three blood purifi cation methods on 20 cases of acute hydrogen arsenide poisoning

[目的]观察三种血液净化方式联合治疗急性砷化氢中毒患者的疗效。[方法]昆明医科大学第一附属医院2002—2011年20例急性砷化氢中毒患者,经基础治疗后,应用血浆置换(PE)、联合血液灌流(HP)及连续静脉静脉血液滤过(CVVH)治疗,观察治疗前后临床表现及实验室指标。[结果]20例急性砷化氢中毒患者在入院前均出现了畏寒、发热、头痛、乏力、腰背部酸痛、巩膜皮肤黄染、贫血等症状及不同程度血红蛋白尿,经治疗4~12 d后上述症状及体征减轻直至消失。入院时血红蛋白下降(104.0 g/L),丙氨酸转氨酶、天门冬氨酸转氨酶、肌酸激酶、乳酸脱氢酶、总胆红素、非结合胆红素、结合胆红素、肌酐和尿素氮均升高(分别为104.1、101.5、251.5、1 802.5 U/L,96.0、82.5、13.1、168.7μmol/L,13.3 mmol/L);治疗第3天,总胆红素、非结合胆红素明显下降至29.1和16.3μmol/L;治疗第10天,红细胞和血红蛋白低于正常值下限,丙氨酸转氨酶和肌酐高于正常值上限,总胆红素、非结合胆红素、天门冬氨酸转氨酶、肌酸激酶、乳酸脱氢酶、尿素氮均恢复正常。透析液和尿液中的砷质量浓度在治疗后第3天恢复正常。6周随访时,所有实验室指标恢复正常。[结论]PE、HP及CVVH联合治疗对急性砷化氢中毒有较好的疗效。

[ Objective ] To observe the effect of a combination therapy of three blood purification methods on acute hydrogen arsenide poisoning. [ Methods ] Twenty patients with acute hydrogen arsenide poisoning were recruited from The First Affiliated Hospital of Kunming Medical University from 2002 to 2011, and received a combination of plasma exchange （PE）, hemoperfusion （HP）, and continuous veno-venous hemofiltration （CVVH） after basic treatment. The clinical manifestations and laboratory indicators were observed before and after the combined treatment. [ Results ] All the 20 patients with acute hydrogen arsenide poisoning appeared symptoms of chills, fever, headache, fatigue, lumbar back pain, scleral skin yellowing, anemia, and varying degrees of hemoglobinuria before admission. Above symptoms were alleviated to disappear after the combined treatment for 4-12 days. Hemoglobin （104.0 g/L） was decreased on admission, while alanine aminotransferase （104.1 U/L）, aspartate aminotransferase （101.5 U/L）, creatine kinase （251.5 U/L）, lactate dehydrogenase （1802.5 U/L）, total bilirubin （96.0 μmol/L）, non-binding bilirubin （82.5 μmol/L）, bilirubin （13.1 μmol/L）, creatinine （168.7 μmol/L）, and urea nitrogen （13.3 mmol/L） were increased. Total bilirubin （29.1 μmol/L） and non-binding bilirubin （16.3 μmol/L） were decreased obviously after 3 days of treatment. Red blood cells and hemoglobin were lower than the lower limit of normal, and alanine aminotransferase and creatinine were higher than the upper limit of normal after 10 days of treatment. Total bilirubin, non-binding bilirubin, aspartate aminotransferase, creatine kinase, lactate dehydrogenase, and urea nitrogen returned to normal after 10 days of treatment. The arsenic concentrations in dialysate and urine returned to normal after 3 days of treatment. All laboratory indicators returned to normal after the follow-up 6 weeks. [ Conclusion ] The combination of PE, HP, and CVVH is effective for the treatment of acute hydrogen arsenide poisoning.