不同血液净化方式治疗急性毒蕈中毒患者多脏器功能衰竭的疗效观察

Observation on the effect of different blood purification methods on multiple organ failure in patients with acute toadstool poisoning

目的对比血流灌流(HP)联合血液透析(HD)与HP联合血浆置换(PE)两种血液净化方式治疗急性毒蕈中毒患者多脏器功能衰竭(MSOF)的临床效果。方法前瞻性分析2018年6月至2020年11月攀枝花市中心医院收治的46例急性毒蕈中毒合并MSOF患者的临床资料。采用随机入院序列号分组法将其均为两组,每组各23例。对照组给予HP联合HD治疗,观察组给予HP联合PE治疗。比较两组治疗期后血浆蛋白结合毒素、血清趋化因子和肝、肾、心肌、凝血功能指标变化情况。结果两组治疗后血浆蛋白结合毒素、血清趋化因子水平和肝、肾、心肌、凝血功能指标较治疗前均明显改善,差异均有统计学意义(P<0.05)。观察组治疗后血浆蛋白结合毒素芳香氨基酸、内毒素、血氨水平明显低于对照组[(1.02±0.25)mg/dLvs.(2.23±0.59)mg/dL、(0.23±0.07)EU/mLvs.(0.69±0.22)EU/mL、(100.28±33.14)μg/Lvs.(197.87±15.98)μg/L],差异均有统计学意义(P<0.05);观察组血清趋化因子配体16(CXCL-16)、诱导蛋白-10(IP-10)、CC亚族趋化因子配体20(CCL20)水平均明显低于对照组[(1.99±0.40)ng/mL vs.(3.04±1.00)ng/mL、(48.49±12.09)pg/mLvs.(62.75±21.29)pg/mL、(56.12±11.48)pg/mLvs.(76.58±16.87)pg/mL],差异均有统计学意义(P<0.05)。观察组肝功能指标天冬氨酸氨基转移酶(AST)、终末期肝病模型(MELD)评分和心肌指标肌酸激酶(CK)、心肌蛋白水平明显低于对照组[(187.74±64.05)U/Lvs.(338.57±117.02)U/L、(6.22±2.08)分vs.(8.18±2.24)分、(95.90±23.73)U/Lvs.(121.96±40.49)U/L、(47.12±12.99)μg/Lvs.(69.30±16.75)μg/L],凝血指标活化部分凝血活酶时间(APTT)和凝血酶原时间(PT)明显短于对照组[(33.74±2.12)svs.(36.52±2.50)s、(8.18±2.24)svs.(14.48±2.00)s],差异均有统计学意义(P<0.05);但肾功能指标尿素、尿肌酐(Cre)与对照组比[(7.75±2.38)μmol/Lvs.(8.57±2.53)μmol/L、(159.60±59.14)μmol/Lvs.(163.80±56.90)μmol/L],差异无统计学意义(P>0.05)。结论急性毒蕈中毒患者MSOF血液净化治疗中选用HP联合PE疗效确切,能有效清除体内毒素,降低机体炎症反应,改善患者心、肝、肾和凝血功能。

Objective To compare the clinical effects of hemoperfusion(HP)combined with hemodialysis(HD)and HP combined with plasma exchange(PE)in the treatment of multiple systemic organ failure(MSOF)in patients with acute toadstool poisoning.Methods From June 2018 to November 2020,46 patients with acute toadstool poisoning combined with MSOF admitted to Panzhihua Central Hospital were prospectively analyzed,and were divided into two groups by random admission sequence number grouping method.The control group was treated with HP combined with HD,and the observation group was treated with HP combined with PE.The changes of plasma protein-binding toxins,serum chemokines,liver,kidney,myocardium,and coagulation function indexes were compared between the two groups after the treatment period.Results Plasma protein-binding toxins,serum chemokine levels,and liver,kidney,myocardial,and coagulation function indexes were significantly improved after treatment in the two groups compared with those before treatment,the differences were statistically significant(P<0.05).After treatment,the plasma protein-bound toxin aromatic amino acid,endotoxin,and blood ammonia levels in the observation group were significantly lower than those in the control group[(1.02±0.25)mg/dL vs.(2.23±0.59)mg/dL,(0.23±0.07)EU/mL vs.(0.69±0.22)EU/mL,(100.28±33.14)μg/L vs.(197.87±15.98)μg/L],the differences were statistically significant(P<0.05).The levels of serum chemokines CXC ligand 16(CXCL-16),interferon-γ-inducible protein 10(IP-10),and CC subgroup chemokine ligand 20(CCL20)in the observation group were significantly lower than those in the control group[(1.99±0.40)ng/mL vs.(3.04±1.00)ng/mL,(48.49±12.09)pg/mL vs.(62.75±21.29)pg/mL,(56.12±11.48)pg/mL vs.(76.58±16.87)pg/mL],the differences were statistically significant(P<0.05).The liver function indexes aspartic transaminase(AST),model for end-stage liver disease(MELD)score,myocardial indexes creatine kinase(CK),and myocardial protein levels in the observation group were significantly lower than those in the control group[(187.74±64.05)U/L vs.(338.57±117.02)U/L,(6.22±2.08)points vs.(8.18±2.24)points,(95.90±23.73)U/L vs.(121.96±40.49)U/L,(47.12±12.99)μg/L vs.(69.30±16.75)μg/L],the coagulation indexes activated partial thromboplastin time(APTT)and prothrombin time(PT)were significantly shorter than those in the control group[(33.74±2.12)s vs.(36.52±2.50)s,(8.18±2.24)s vs.(14.48±2.00)s],the differences were statistically significant(P<0.05),but there was no significant difference between the two groups of urea and creatinine(Cre)[(7.75±2.38)μmol/L vs.(8.57±2.53)μmol/L,(159.60±59.14)μmol/L vs.(163.80±56.90)μmol/L](P>0.05).Conclusion HP combined with PE in MSOF blood purification treatment for patients with acute mushroom poisoning has a definite effect,which can effectively remove toxins from the body,reduce inflammation in the body,and improve the heart,liver,kidney and blood coagulation functions of the patients.