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疗效比较

发布时间：2018-04-02 12:37

本文选题：毒蕈中毒　切入点：血液灌流　出处：《吉林大学》2017年硕士论文

【摘要】：目的:通过回顾性分析吉林大学第一医院收治的37例重症毒蕈中毒(poisonous mushroom poisoning,PMP)患者的临床资料,观察和评价血液灌流(Hemoperfusion,HP)联合连续性静脉-静脉血液滤过(Continuous Veno-Venous Hemofiltration,CVVH)与单纯CVVH治疗PMP的疗效比较,为临床中优化PMP治疗提供更多的理论依据。方法:通过回顾性分析2015年8月至2016年10月吉林大学第一医院收治的37例重症急性PMP并发中毒性肝损伤、急性肾衰竭、中毒性心肌炎、中毒性脑病、急性血管内溶血等患者的临床资料。依据PMP患者接受不同的治疗方法分为CVVH+HP组和CVVH组。CVVH+HP组21例,采用持续血液滤过24h串联灌流2h;CVVH组16例,采用单纯血液滤过24h,疗程均2~3天。所有患者的内科常规治疗基本相同,HP实施的主要依据是从患者入院时黄疸、胆红素升高的严重程度来判断。37例患者比较治疗5天后谷草转氨酶(AST)、谷丙转氨酶(ALT)、总胆红素(TB)、间接胆红素(IB)、肌酐(Cr)、尿素氮(BUN)、凝血酶原时间(PT)、部分凝血酶原时间(APTT),临床症状以及APACHE II评分的改善程度,统计其住院天数。所有数据采用SPSS23.0软件进行统计学分析,计量资料用均数±标准差(x±s)表示,样本均数的比较采用t检验,率的比较采用?2检验,P0.05表示差异有统计学意义。结果:两组治疗前病情严重程度基本无差异(P0.05);CVVH+HP组患者黄疸、少尿、血尿等症状明显减轻,优于CVVH组(P0.05);CVVH+HP组患者血清AST、ALT、TB、IB、PT、APTT水平较治疗前明显降低,与CVVH组相比均有统计学差异(P0.05);CVVH+HP组治疗后APACHE II评分呈下降趋势,至第5天明显低于治疗前和CVVH组(P0.05);两组住院天数比较差异有统计学意义(P0.05)。结论:毒蕈中毒患者常合并多脏器功能损害,及早进行HP联合CVVH治疗较单纯CVVH治疗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。
[Abstract]:Objective: to retrospectively analyze the clinical data of 37 patients with toxic mushroom poisoning (mushroom) in the first Hospital of Jilin University.To observe and evaluate the curative effect of continuous Veno-Venous hemofiltration combined with continuous Veno-Venous hemofiltration (CVVH) and simple CVVH in the treatment of PMP, and to provide more theoretical basis for the optimization of PMP therapy in clinic.Methods: from August 2015 to October 2016, 37 cases of severe acute PMP complicated with toxic liver injury, acute renal failure, toxic myocarditis and toxic encephalopathy were retrospectively analyzed.Clinical data of patients with acute intravascular hemolysis.According to different treatment methods, PMP patients were divided into CVVH HP group (n = 21) and CVVH group (n = 21). 16 patients were treated with continuous hemofiltration for 24 h and continuous hemofiltration for 2 h (n = 16).For all patients, routine medical treatment was basically the same. The main basis for the implementation of HP was jaundice on admission.To judge the severity of bilirubin elevation in 37 patients after 5 days of comparative treatment, the levels of glutamic oxaloacetic transaminase (AST), alanine aminotransferase (alt), total bilirubin (TBN), indirect bilirubin (IBN), creatinine (Cr), urea nitrogen (bun), prothrombin time (PTT), partial prothrombin time (PT), and partial prothrombin time (APTTT) were determined.The improvement of clinical symptoms and APACHE II score,The number of days in hospital was counted.All the data were analyzed by SPSS23.0 software, the measurement data were expressed by mean 卤standard deviation (x 卤s), the mean of samples was compared by t test, and the rate of data was compared by means of 2 test (P0.05).Results: there was no significant difference in the severity of the disease between the two groups before treatment. The symptoms of jaundice, oliguria and hematuria in the CVVHHP group were obviously alleviated, which was better than that in the CVVH group.Compared with the CVVH group, the APACHE II score of the P0.05 + CVVHHP group decreased, and was significantly lower than that of the CVVH group before treatment and CVVH group, and the difference between the two groups was statistically significant (P 0.05).Conclusion: patients with mushroom poisoning often have multiple organ dysfunction. Early treatment with HP combined with CVVH can remove protein-binding toxin and serum inflammatory factors more effectively than that of CVVH alone, thus reducing the damage of visceral organs and improving liver.Kidney and blood coagulation function, treatment effect is remarkable.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R595.7

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