不同的血液净化疗法治疗毒蕈中毒的临床疗效评价

Clinical evaluation of different blood purification therapy for poisonous mushroom poisoning

关键词:  毒蕈中毒  血液透析  血液灌流  血浆置换

Key words:  poisonous mushroom poisoning  hemodialysis  hemoperfusion  plasma exchange

摘要:

目的　探讨血液透析（hemodialysis，HD）、血液灌流（hemoperfusion，HP）、血液灌流联合血浆置换（plasma exchange，PE）在治疗毒蕈中毒中的临床疗效。　方法　依据71例毒蕈中毒患者接受不同的治疗方法分为：常规治疗组：药物治疗，共19例；HD组：常规治疗+HD，共12例；HP组：常规治疗+HP，共23例；HP联合PE组：常规治疗+HP+PE，共17例。动态观察HD组患者入院第1、3、5、7天的血肌酐（Scr）、血尿素氮（Urea）及尿量，自身对比在不同时间段内患者Scr、Urea及尿量的变化情况。常规治疗组、HP组、HP联合PE组患者均出现不同程度的肝脏、凝血、神经系统受损，无肾脏受损，动态观察三组患者入院第1、3、5、7天的谷草转氨酶（AST）、谷丙转氨酶（ALT）、总胆红素（TB）、凝血酶原时间（PT-T）、活化部分凝活酶时间（APTT），比较三组患者在治疗不同时间段AST、ALT、TB、PT-T、APTT的变化情况。　结果　（1）HD组患者治疗后Scr、Urea呈下降趋势并伴有尿量恢复。（2）HP联合PE组患者的肝酶、胆红素短期内恢复程度明显优于常规治疗组及HP组，对纠正患者的PT-T、APTT的延长显效较快，差异均有统计学意义（P＜0.05）。　结论　毒蕈中毒所致急性损伤，应尽早应用HD治疗。应用HP联合PE治疗在改善毒蕈中毒患者肝功能及凝血功能的异常方面，短期内可取得较满意的疗效。

Abstract:

Objective Retrospective analysis of clinical data of 71 cases of poisonous mushroom poisoning, to evaluate the clinical efficacy of hemodialysis (HD), hemoperfusion (HP), plasma exchange (PE) therapies for mushroom poisoning and to provide more theoretical basis for optimizing clinical treatment of poisonous mushroom poisoning. Methods According to different treatment methods, the patients were divided into 4 groups including routine therapy group (19 cases), HD group (12 cases), HP group (23 cases), and HP combined with PE group (17 cases). The HD group patients were dynamically monitored for Scr, Urea and urine volume. The other three groups of patients showed varying degrees of liver, coagulation and nervous system damage. No kidney damage was observed. These patients were monitored for serum level changes of AST, ALT, TB, PT-T, and APTT after admission to the hospital. Results After treatment, the HD group patients had progressively decreased Scr and Urea levels and gradually increased urine volume (P<0.05). After seven days of treatment, serum levels of AST, ALT and TB decreased significantly in HP combined with PE group compared to conventional treatment group and HP group; serum levels of AST and ALT declined more in HP group than those in conventional treatment group. HP combined PE treatment corrected the patients’ PT-T and APTT markedly faster than HP (P<0.05). Conclusion Hemodialysis should be used as soon as possible to treat acute injury caused by poisonous mushroom poisoning. The application of hemoperfusion combined with plasma exchange improves liver function and coagulation function and can obtain satisfactory curative effect in the short term.