肝损伤型毒蕈中毒的救治效果分析

Efficacy of treatment of mushroom poisoning with liver injury

目的探讨毒蕈中毒的临床特点和救治要点。方法对同批5例肝损伤型毒蕈中毒患者于中毒3 d入院后的临床特点、氨基转移酶(ALT)、凝血功能(PT)、血小板数(PLT)和胆红素(TBIL)等变化进行回顾性分析。结果中毒后第4天所有患者ALT、TBIL已明显升高,其中重症者ALT于第4天已达到高峰,随后快速下降,而TBIL进行性升高,于第7天后维持在高峰状态(TBIL>350μmol,ALT<300 U/L),呈现"酶-胆分离"现象;中毒后第4天重症者PT活性显著降低(PT<20%),PLT随病情发展快速降低(PLT<50×10~9/L),并维持在低水平;重症者约中毒4天后进入肝性昏迷,10 d内死亡。结论尽早全肠灌洗、预见性血液灌流或早期血浆置换等是救治肝损伤型毒蕈中毒的关键。

Objective To investigate the clinical characteristics and treatment of mushroom poisoning.Methods The clinical characteristics were analyzedin5 cases of mushroom poisoning with liver injury hospitalized after three days.The changes of alanine transaminase (ALT),coagulation function (PT),platelet count(PLT),bilirubin(TBIL)and other parameterswere retrospectively evaluated. Results After poisoning,ALT and TBIL increased significantly on the 4th day;In critical patients,ALT peaked on day 4,followed by a rapid decline;TBIL continually increasedand maintained peak state (TBIL>350 μmol,ALT <300 U/L),and “enzyme-jaundice separation”appeared on the 7th day;PT was significantly reduced(PT<20%)on day 4;PLT decreasedrapidly with progression of disease(PLT<50 × 1 04/L).The two indexes maintained at a low level in the following days;severe cases progressedto the hepatic coma after 4 days ,and died after 1 0 days.Conclusion Forpatients with hepatic type of toadstool toxicosis,the whole gut lavage,blood filling flow or plasma exchange to remove the toxin in time arethe keys to successful rescue.