群体性致命鹅膏中毒的救治

Treatment of group Amanita exitialis poisoning

目的 探讨群体性致命鹅膏中毒的救治方法,总结群体性致命鹅膏中毒的救治策略。方法 回顾性纳入2023年7月31日云南大学附属医院急诊医学部收治的群体性致命鹅膏中毒患者,对患者进行病情分级,分析患者的临床资料、救治方法及血液净化选择模式等相关数据。结果 共纳入群体性致命鹅膏中毒患者6例,平均年龄52岁。病情分级为Ⅰ、Ⅱ级的患者各2例,Ⅲ、Ⅳ级各1例。Ⅰ级患者选择血液灌流(hemoperfusion,HP)单一单次模式,Ⅱ级选择HP单一多次模式,Ⅲ级选择HP与血浆置换联合多次模式,Ⅳ级选择HP、血浆置换、双重血浆分子吸附与连续性肾脏替代治疗联合多次模式治疗。经个体化综合治疗后,5例患者治愈出院,1例患者死亡。结论 群体性鹅膏中毒的救治除药物基础治疗外,需先综合考虑血液净化副作用与患方经济条件等因素,再根据患者不同病情分级,选择血液净化单一或联合、单次或多次模式治疗,尽早选择恰当的个体化血液净化模式治疗可为中毒患者有效争取时间。

Objective To explore the treatment methods for group Amanita exitialis poisoning,and summarize the treatment strategies for group Amanita exitialis poisoning.Methods A group of Amanita exitialis poisoning patients admitted to the Department of Emergency Medicine of the Affiliated Hospital of Yunnan University on July 31,2023 were retrospectively included.We graded the patients’condition and analyzed their clinical data,treatment methods,and blood purification selection modes.Results A total of 6 patients with Amanita exitialis poisoning were included,with an average age of 52 years.There were 2 patients with gradeⅠ,2 patients with gradeⅡ,1 patient with gradeⅢand 1 patient with gradeⅣ.GradeⅠpatients choosed single one mode hemoperfusion(HP),gradeⅡpatients choosed single multiple mode HP,gradeⅢpatient choosed multiple mode HP combined with plasma exchange,and gradeⅣpatient choosed multiple mode HP combined with plasma exchange,double plasma molecular adsorption system and continuous renal replacement therapy.After individualized comprehensive treatment,5 patients were cured and discharged,and 1 patient died.Conclusions In the treatment of group Amanita exitialis poisoning,in addition to basic drug treatment,it is necessary to first consider factors such as the side effects of blood purification and the economic conditions of the patient.Then,according to the different disease grades of the patient,single or combined blood purification,single or multiple treatment modes can be choosed.Early selection of appropriate individualized blood purification modes can effectively buy time for poisoning patients.