灵芝煎剂联合序贯血液净化治疗重症毒蕈中毒的临床疗效观察

Clinical efficacy discussion of ganoderma decoction combined with sequential blood purification therapy on patients with the severe poisonous mushroom poisoning

目的探讨灵芝煎剂联合序贯血液净化治疗重症毒蕈中毒(PMP)患者的临床疗效。方法通过回顾性分析2014年3月~2017年8月我科收治的42例重症PMP患者的临床资料,依据患者接受不同的治疗方法分为联合治疗组和CVVH组。联合治疗组26例,在患者入院后给予常规治疗基础上,每天予以灵芝煎剂口服或鼻饲,同时予以序贯血液灌流(HP)+连续静脉-静脉血液滤过(CVVH)联合治疗。CVVH组16例,在患者入院后给予常规治疗基础上,单纯行CVVH治疗。观察比较两组患者临床疗效。结果联合治疗组患者治疗后第5、7天总胆红素(STB)与谷丙转氨酶(ALT)以及入院后第5天的乳酸脱氢酶(LDH)、肌酸激酶(CK)与肌酸激酶同工酶(CK-MB)、入院后第5、7、10天的乳酸(Lac)、尿素氮(BUN)及肌酐(Cr)均明显下降,与CVVH组比较差异均有统计学意义(P<0.05)。两组患者ICU住院时间、总住院时间、住院总费用和28天病死率比较,差异均有统计学意义(P<0.05)。结论与单纯CVVH治疗相比较,灵芝煎剂联合序贯血液净化治疗PMP更能有效改善患者肝、肾功能,降低乳酸及肌酶水平,并能缩短患者ICU住院时间与总住院时间,减少了患者的总住院费用,降低了死亡率。

Objective To explore the clinical efficacy of ganoderma decoction combined with sequential blood purification therapy on patients with the severe poisonous mushroom poisoning(PMP). Methods The clinical data of 42 patients with severe PMP were analyzed retrospectively during the period from March 2014 to Augest 2017.The patients were divided into combination therapy group and CVVH group according to different treatment methods.Patients of combined treatment group(26 cases)were taken oral or nasal feeding of Ganoderma Capsule on the basis of internal routine treatment daily,while received hemoperfusion(HP)combined with continuous veno-venous hemofiltration(CVVH)sequentially.However the patients of CVVH group(16 cases)only received CVVH on the basis of internal routine treatment daily.The clinical data of the two groups were compared and the effects was evaluated. Results Compared with CVVH group,the levels of STB and ALT of combination group on 5 th and 7 th days after admission,LDH,CK and CK-MB on 5th day after admission and Lac,BUN and Cr on 5th,7thand 10th days after admission were significantly decreased,and the difference between the two groups was significant statistically(P<0.05);Compared with the ICU length of hospitalization time,total hospitalization days,total hospitalization expenses and 28 days case fatality rate,the difference between the two groups was significant statistically(P<0.05). Conclusion Compared with CVVH alone,that ganoderma lucidum decoction combined with sequential blood purification treatment can effectively improve the function of liver and kidney,reduce the levels of Lac and muscle enzyme,shorten the ICU length of hospitalization time and total hospitalization days,and in particular,reduce the total hospitalization expenses and mortality of patients of PMP.