血液灌流联合血液透析治疗儿童重症毒蕈中毒临床分析

Clinical analysis on hemoperfusion combined with hemodialysis in the treatment of children with severe mushroom poisoning

目的总结儿童重症毒蕈中毒的临床特点,评价血液灌流(Hemoperfusion,HP)联合血液透析(Hemodialysis,HD)治疗儿童重症毒蕈中毒的疗效。方法对2011年1月至2016年2月江西省儿童医院收治28例重症毒蕈中毒患儿的临床资料进行回顾性分析,根据预后分为生存组19例及死亡组9例,对患儿行HP联合HD治疗前后肝功能、心肌酶谱及肾功能进行统计学分析。结果进行HP联合HD治疗后生存组谷丙转氨酶(Alanine aminotransferase,ALT)、谷草转氨酶(Aspartate transaminase,AST)、总胆红素(Total bilirubin,TBil)、直接胆红素(Direct bilirubin,DBil)、乳酸脱氢酶(Lactate dehydrogenase,LDH)、肌酸激酶(Creatine Kinase,CK)、肌酸激酶同工酶(MB isoenzyme of creatine kinase,CK-MB)及肌酐(Creatinine,Cr)水平均明显低于死亡组,生存组HP联合HD治疗后ALT、AST、白蛋白(Albumin,ALB)、LDH、CK、CK-MB、尿素(Blood urine nitrogen,BUN)及Cr水平均明显低于治疗前,无肝性脑病并发症患儿病死率低于合并肝性脑病者,差异有统计学意义(P<0.05)。结论 HP联合HD治疗对儿童重症毒蕈中毒是一种有效的治疗手段,重症毒蕈中毒出现肝性脑病并发症时死亡率高。

Objective To summarize the clinical characteristics of children with severe mushroom poisoning,and evaluate the curative effect of hemoperfusion(HP) combined with hemodialysis(HD) in the treatment of children with severe mushroom poisoning. Methods The clinical data of 28 cases of children with severe mushroom poisoning in Jiangxi province Children's hospital were retrospectively study from January 2011 to February 2016. According to the prognosis of the patients,19 patients were divided into survival group and 9 patients in the death group,the liver function、myocardial enzyme spectrum and renal function before and after HP combined with HD in the treatment of patients were statistically analyzed. Results Alanine aminotransferase(ALT)、aspartate transaminase(AST)、total bilirubin,(TBil)、direct bilirubin(DBil)、lactate dehydrogenase(LDH)、creatine Kinase(CK)、MB isoenzyme of creatine kinase(CK-MB) and creatinine(Cr) levels of survival group were significantly lower than death group after HP with HD therapy. ALT、AST、albumin(ALB)、LDH、CK、CK-MB、blood urine nitrogen(BUN)and Cr levels of survival group after HP with HD therapy were significantly lower before the treatment,the morbidity of patients with no complications of hepatic encephalopathy was lower than that of the patients with complications of hepatic encephalopathy,the difference is statistically significant. Conclusion Treatment of HP combined with HD in children with severe mushroom poisoning is a kind of effective treatment means,severe mushroom poisoning complications of hepatic encephalopathy has a high mortality rate.