不同血液净化方式治疗毒蕈中毒的临床观察

Clinical observation of different ways of blood purification for treating poisonous mushroom poisoning

目的探讨不同血液净化方式治疗毒蕈中毒(PMP)的临床疗效。方法回顾性选取2013年3月至2018年3月因PMP就诊于西南医科大学附属医院伴有中毒性肝炎或肾损伤、心肌炎、凝血功能异常的患者184例,所有患者在常规内科综合治疗基础上根据不同血液净化治疗方式分为血液透析组(HD组)、血液灌流组(HP组)、血浆置换组(PE组)、血液灌流+血液透析组(HP+HD组)、血浆置换+血液透析组(PE+HD组)、血浆置换+血液灌流组(PE+HP组);其中HD组、HP+HD组及PE+HD组存在肾脏损伤,HP组、PE组及PE+HP组无肾脏损伤;观察治疗7 d后血ALT、AST、TBIL、DBIL、Crea、Urea、PT、APTT、CK-MB及肌红蛋白等指标变化情况,并统计住院天数及病死率。结果 PE+HP组、HP组及PE组治疗7 d后,血ALT、AST、TBIL、DBIL、PT、APTT、CK-MB及肌红蛋白等均较前明显下降;其中在改善ALT、AST、TBIL、DBIL、CK-MB及肌红蛋白方面,PE+HP组治疗效果明显优于PE组及HP组(P <0.05);在改善PT、APTT方面,PE+HP组及PE组较HP组治疗效果好(P <0.05);PE+HP组平均住院时间及病死率明显低于HP组与PE组(P <0.05);部分PMP患者合并急性肾损伤(AKI),其中HD组、HP+HD组及PE+HD组治疗7 d后,血Crea、Urea水平均较前明显下降;HP+HD组及PE+HD组血Crea、Urea水平下降幅度明显大于HD组(P <0.05),住院时间及病死率更低(P <0.05)。结论 PE联合HP治疗PMP优势更明显,能更快、迅速有效地清除血中毒蕈毒素及其代谢产物,促进各损害器官的恢复,对降低平均住院日、改善预后有很大帮助。PMP可引起AKI,且HD治疗有效,若在PMP初期及时行PE或HP治疗后再行HD治疗效果更好。

Objective To investigate the clinical efficacy of different ways of blood purification for treating PMP. Methods 184 PMP patients with toxic liver hepatitis or renal injury,toxic myocarditis,or coagulopathy in our hospital from March 2013 to March 2018 were recruited for retrospective analysis. All patients received comprehensive medical treatment and were divided into six groups based on different ways of blood purification: HD group,HP group,PE group,HP + HD group,PE + HD group,PE+HP group. Among these groups,patients in HD group,HP + HD group,and PE + HD group had kidney damage;and partients in HP group,PE group and PE + HP group did not have kidney damage. Changes of ALT,AST,TBIL,DBIL,Crea,Urea,PT,APTT,CK.MB, and myoglobin were observed after 7 days of treatment. Length of stay and mortality were recorded. Results After 7 days of treatment,ALT,AST,TBIL,DBIL,PT,APTT,CK-MB and myoglobin significantly decreased in PE + HP group,HP group and PE group. The indices of ALT,AST,TBIL,DBIL,CK-MB and myoglobin were obviously improved in PE + HP group,compared to PE group and HP group(P < 0.05). The indices of PT and APTT in HP group had no significant improvement,compared to PE + HP group and PE group. The average length of stay and mortality in PE + HP group were significantly lower than HP group and PE group(P < 0.05). For some patients with PMP combined with acute kidney injury(AKI)in HD,HP + HD and PE + HD groups,the levels of Crea and Urea significantly decreased after 7 days of treatment. And the levels of Crea and Urea in HP + HD group and PE + HD group decreased more than HD group(P < 0.05). In addition,the length of stay and mortality were lower(P < 0.05)in HP + HD group and PE + HD group. Conclusion Combination therapy of PE and HP for treating PMP have advantages in removing toxins and metabolites more quickly and effectively,and thus promoting the recovery of organ damages,reducing the hospital stay,and improving the prognosis. PMP can induce AKI,HD treatment is effective. And we will have better clinical efficacy treated with HD after treated with PE or HP in the early stage of PMP.