摘要
目的 :观察序贯性血液净化治疗重度毒鼠强中毒患者的临床疗效和对预后的影响 ,及对毒鼠强的清除作用。 方法 :18例重度毒鼠强中毒患者入院后 ,除给予常规治疗外 ,同时进行序贯性活性炭血液灌流 (HP)治疗 3～ 5h ,随后立即进行连续性静脉 静脉血液滤过 (CVVH)治疗 2 4～ 36h。观察患者血压、脉搏、血常规及血清酶学变化 ,测定HP治疗前、后血浆中毒鼠强浓度 ,及CVVH治疗 2h、12h滤器前、后血浆及超滤液中毒鼠强浓度。 结果 :患者在中毒 12h内即进行血液净化治疗 (8例 ) ,死亡 1例 ,其余患者痊愈 ;晚期患者在中毒 12h后才进行血液净化治疗 (10例 ) ,2例死亡 ,1例呈去大脑皮层状态 ,1例精神异常。较早治疗患者痊愈率显著高于晚期治疗患者(87 5 %vs 6 0 % ,P <0 0 5 ,χ2 检验 ) ,而痊愈患者平均昏迷时间 5～ 6 0 (2 3 0± 19 9)h ,明显比晚期治疗痊愈患者短[2 0～ 96 (5 9 7± 2 7 7)h ,P <0 0 1,秩和检验 ]。HP治疗后血浆中毒鼠强浓度从 (0 12 4± 0 0 82 )mg/L降至 (0 0 80±0 0 5 5 )mg/L。CVVH治疗 2h及 12h血浆毒鼠强浓度分别为 (0 0 78± 0 0 6 4 )mg/L ,及 (0 0 74± 0 0 5 9)mg/L ,2h及 12h毒鼠强筛选系数分别为 0 839± 0 4 0 9,0 6 86± 0 2 5 3。CVVH治疗 2h
Objective:To investigate the therapeutic effects of sequential hemoperfusion(HP) and continuous venovenous hemofiltration (CVVH) in patients with severe tetramine poisoning,and to evaluate the removal of plasma tetramine by these modalities in these patients. Methodology:Eighteen patients with severe tetramine poisoning (17 in persisting coma,and 15 patients need mechanical ventilation) were treated with HP using activated charcoal for 3～5 hours and consecutive CVVH for 24～36 hours,besides routine medical therapy.APACHE Ⅱ and Glasgow scores were evaluated daily according to the clinical conditions including blood pressure,heart rate,temperature and consciousness.Blood routine and serum biochemical parameters were also tested and evaluated.Plasma tetramine concentration was determined before and after HP treatment.Tetramine concentrations in both pre filter and post filter plasma,and in the ultrafiltrate were also determined at the 2nd hour and the 12th hour of CVVH procedure.In HP treatment,14 patients used 2 adsorbents,and 4 used 1 adsorbent. Results:In the whole patient group,the average APACHE Ⅱ score declined and average Glassgow score increased after the blood purification procedures.In the 8 patients started these procedures in the first 12 hours after onset of poisoning,7 recovered completely,and 1 died of cardiac failure.In the 10 patients started 12 hours after onset of poisoning,6 recovered completely,2 recovered with mental confusion or decerebral state,and 2 died of circulatory and respiratory failure Patients with early initiation of HP and CVVH treatment had higher complete recovery rate than those with later initiation of HP and CVVH treatment (87 5% vs 60 0%, P <0 05, χ 2 test).For patients with complete recovery,hours of persisting coma after the initation of HP and CVVH time were shorter in the early initiation group than those in the later initiation group [5～60(23 0±19 9) hours vs 20～96(59 7±27 7)hours, P <0 01,rank test].In the 14 patients using 2 adsorbents,reduction rate of plasma tetramine after HP was significantly greater than that of patients using 1 adsorbent [was (42 9±14 0)% vs (34 7±13 8)%,( P >0 05)] Consecutive CVVH were performed in 16 patients.During CVVH,mean plasma tetramine concentration was (0 078±0 064)mg/L(ultraflitration sieving coefficient 0 839±0 409)in the 2nd hour and (0 074±0 059)mg/L in 12th hour(ultrafiltration sieving coefficient 0 686±0 253).Plasma tetramine concentration at the 2nd hour of CVVH declined in 15 patients [mean reduction rate (13 2±12 1)%], but increased slightly in 1 patients(increasing rate 9 52%); at the 12th hour of CVVH, plasma concentration declined in 13 patients(mean reduction rate 29 8%±14 5%), but increased slightly in 3 patients [mean increasing rate (11 05±8 00)%] Conclusion:Early initiation sequential HP and CVVH treatment greatly improved the outcome of severe tetramine poisoned patients.HP can obviously reduce the plasma concentration of tetramine,and CVVH can remove tetramine continuously from the plasma and attenuate the plasma tetramine concentration rebound after HP.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
2003年第2期106-111,125,共7页
Chinese Journal of Nephrology,Dialysis & Transplantation
基金
军队"十五"医学研究指令性课题 (NO :0 1L0 0 7)
