血浆置换联合CRRT治疗秋水仙碱中毒的疗效与护理

Efficacy and nursing of plasma exchange combined with continuous renal replacement therapy in the treatment of colchicine poisoning patients

目的探讨血浆置换(PE)联合连续性肾脏替代治疗(CRRT)在秋水仙碱中毒患者中的疗效及护理要点。方法采用观察性研究方法,选择2017年12月至2022年8月在温州医科大学附属第一医院急诊重症监护病房(EICU)救治的19例秋水仙碱中毒患者,分析其临床资料,观察PE联合CRRT治疗后的疗效及护理要点。结果19例秋水仙碱中毒患者中男性15例(78.9%),女性4例(21.1%);平均年龄(50.31±22.22)岁;口服毒物剂量为30~180片(0.5~1.0 mg/片);服药后出现恶心、呕吐、腹痛、腹泻等消化道症状,并发多器官功能障碍、骨髓抑制和红细胞、白细胞、血小板三系下降现象。所有患者行PE联合CRRT治疗后,秋水仙碱浓度从血液净化前最高53.6μg/L下降至<1.0μg/L,17例患者在2周内好转,平均住院天数为9~11 d;最终治愈17例,自动出院2例。结论秋水仙碱中毒患者首发症状以恶心、呕吐、腹痛、腹泻等消化道表现为主;进行床旁PE联合CRRT综合急救与护理,能有效降低患者体内的秋水仙碱浓度,维持循环及内环境稳定,减轻患者的多器官功能损害;同时提供有效的护理干预措施,对患者预后具有非常重要的意义。

Objective To investigate the efficacy and nursing points of plasma exchange(PE)combined with continuous renal replacement therapy(CRRT)in patients with colchicine poisoning.Methods Using an observational study method,19 patients with colchicine poisoning treated in the emergency intensive care unit(EICU)of the First Hospital of Wenzhou Medical University from December 2017 to August 2022 were selected to analyze their clinical data and observe the efficacy and nursing points after PE combined with CRRT treatment.Results Among the 19 patients with colchicine poisoning,15(78.9%)were male and 4(21.1%)were female;the average age was(50.31±22.22)years;the oral dose of the poison ranged from 30 to 180 tablets(0.5-1.0 mg/tablet).After taking the drug,gastrointestinal symptoms such as nausea,vomiting,abdominal pain and diarrhea were observed,complicated by multi-organ dysfunction,bone marrow suppression and erythrocyte,leukocyte and platelet trilineage decline.After all patients were treated with PE combined with CRRT,the colchicine concentration decreased from a maximum of 53.6μg/L before blood purification to<1.0μg/L.Seventeen patients improved within 2 weeks,and the average number of hospitalization days was 9-11 days.Seventeen patients were finally cured,and two were discharged automatically.Conclusions The first symptoms of patients with colchicine poisoning are mainly nausea,vomiting,abdominal pain,diarrhea and other gastrointestinal manifestations.Bedside PE combined with CRRT comprehensive first aid and nursing can effectively reduce the colchicine concentration in patients,maintain the stability of the circulation and internal environment,and reduce the multi-organ functional damage of patients.At the same time,providing effective nursing interventions is of great importance to the prognosis of patients.