血液灌流联合血液滤过与单纯血液滤过治疗重症毒蕈中毒效果比较

doi:10.3969/j.issn.1000-8535.2020.02.006

广州医药 ›› 2020, Vol. 51 ›› Issue (2): 27-30.DOI: 10.3969/j.issn.1000-8535.2020.02.006

血液灌流联合血液滤过与单纯血液滤过治疗重症毒蕈中毒效果比较

林洁羽, 董伟

济宁市第一人民医院急诊内科(济宁 272000)

收稿日期:2019-11-07 出版日期:2020-03-20 发布日期:2021-11-28
通讯作者: 董伟,E-mail:1120421696@qq.com

Clinical effect comparison of hemoperfusion combined with hemofiltration and simple hemofiltration in treatment of patients with severe mushroom poisoning

LIN Jieyu, DONG Wei

Emergency Department,Jining First People's Hospital,Jining 272000, China

Received:2019-11-07 Online:2020-03-20 Published:2021-11-28

摘要/Abstract

摘要： 目的观察和评价重症毒蕈中毒(PMP)患者的临床资料,探讨血液灌流(HP)联合血液滤过(HF)与单独血液滤过治疗的疗效比较。方法收集本院2016年8月—2018年10月救治的32例重症急性毒蕈中毒并发中毒性肝损伤、急性肾衰竭、中毒性心肌炎、消化道出血、中毒性脑病、急性血管内溶血等患者的临床资料,将32例患者分为治疗组和对照组,治疗组14例,采用持续静脉-静脉血液滤过24 h串联灌流2 h;对照组18例,采用单独血液滤过24 h,疗程2～3 d。两组患者内科常规治疗基本相同。结果 14例治疗组在内科常规治疗基础上联合血液灌流+血液滤过,好转率为92.9%(13/14);18例对照组在内科常规治疗基础上单用血液滤过,好转率为61.1%(11/18),两组好转率比较,差异有统计学意义(P<0.05)。治疗组患者黄疸、少尿、黑便、意识障碍等症状减轻,优于对照组;血清AST、ALT、TBil、DBil、PT、APTT水平较治疗前改善,优于对照组,差异有统计学意义(P均<0.05)。结论毒蕈中毒患者常合并多脏器功能障碍(MODS),及早进行血液灌流联合血液滤过治疗较单独血液滤过能更有效的清除蛋白结合毒素和血清炎症因子,从而减轻内脏器官损害,改善肝、肾和凝血功能,治疗效果显著。

关键词: 血液灌流, 血液滤过, 毒蕈中毒, 多脏器功能障碍

Abstract: Objective To compare the clinical effect differences between hemoperfusion combined with hemofiltration with simple hemofiltration in treatment of severe mushroom poisoning patients. Methods 32 patients with toxic hepatitis,toxic myocarditis,toxic encephalopathy and acute renal failure due to poisonous mushroom were divided into two groups: treating group(n=14) and control group(n=18).Patients of treating group received continuous veno-venous hemofiltration for 24 hours combined with hemoperfusion for 2 hours.The cases of control group only received hemofiltration for 24 hours. Results After the treatment,the improvement rate in treating group were higher than that in control group(P<0.05).The disturbance of consciousness,jaundice,oliguria,melena in treating group were improved obviously and serum levels of AST、ALT、TBil、DBil、PT、APTT were reduced than those in controls(P<0.05). Conclusion Compared with simple hemofiltration,early hemoperfusion combined with hemofiltration for patients with severe toadstool poisoned can not only remove protein binding toxin and serum inflammatory factors,but also improve liver,kidney and coagulation function.

Key words: Hemoperfusion, Hemofiltration, Mushroom poisoning, MODS

林洁羽, 董伟. 血液灌流联合血液滤过与单纯血液滤过治疗重症毒蕈中毒效果比较[J]. 广州医药, 2020, 51(2): 27-30.

LIN Jieyu, DONG Wei. Clinical effect comparison of hemoperfusion combined with hemofiltration and simple hemofiltration in treatment of patients with severe mushroom poisoning[J]. Guangzhou Medical Journal, 2020, 51(2): 27-30.

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血液灌流联合血液滤过与单纯血液滤过治疗重症毒蕈中毒效果比较

Clinical effect comparison of hemoperfusion combined with hemofiltration and simple hemofiltration in treatment of patients with severe mushroom poisoning

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