不同的血液净化疗法治疗毒蕈中毒的临床疗效评价

发布时间：2019-05-18 11:11

【摘要】：目的：通过回顾性分析大连医科大学附属第二医院收治的71例毒蕈中毒（poisonous mushroom poisoning，PMP）患者的临床资料，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PMP中的临床疗效，为临床中优化治疗PMP提供更多的理论依据。方法：通过回顾性分析1997年06月至2013年09月期间大连医科大学附属第二医院收治的因PMP导致肝脏、肾脏、凝血、神经系统中存在一种或多种系统受损的71例患者的临床资料。依据PMP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。HD组患者仅出现肾脏受损，无肝脏、凝血、神经系统受损，动态观察HD组患者入院第1d、3d、5d、7d的血肌酐（Scr）、血尿素（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1d、3d、5d、7d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。总结应用HD、HP、HP联合PE在治疗PMP过程中出现的相关并发症（恶心、呕吐、低血压、过敏反应、凝血、肌肉痉挛）的次数及发生率。系统评价HD、HP、HP联合PE在治疗PMP中的临床疗效。所有数据均采用SPSS19.0软件进行统计学分析，标准为0.05，P＞0.05无统计学差异，P＜0.05有统计学差异；计量资料以均数±标准差（Mean±SD）表示，同组资料治疗前后的对比采取配对样本均数t检验，多个治疗组间的比较采取单因素方差分析；计数资料用频数及率表示，计数资料间的比较采用X2检验。结果：1、常规治疗组、HD组、HP组、HP联合PE组患者的年龄、性别、食用毒蕈（poisonous mushroom，PM）至首次就诊时间的比较，P＞0.05，无统计学差异。2、71例PMP患者并发中毒性肝损伤38例、急性肾损伤12例、中毒性肝损伤+弥漫性血管内凝血（Disseminated intravascular coagulation，DIC）10例、中毒性肝损伤+中毒性脑病7例、中毒性肝损伤+DIC+中毒性脑病4例。3、常规治疗组患者并发中毒性肝损伤17例、中毒性肝损伤+DIC1例、中毒性肝损伤+中毒性脑病1例，死亡2例；HD组患者并发急性肾损伤12例，无死亡；HP组患者并发中毒性肝损伤15例、中毒性肝损伤+中毒性脑病3例、中毒性肝损伤+DIC3例、中毒性肝损伤+DIC+中毒性脑病2例，死亡3例；HP联合PE组患者并发中毒性肝损伤6例、中毒性肝损伤+中毒性脑病3例、中毒性肝损伤+DIC6例、中毒性肝损伤+DIC+中毒性脑病2例，无死亡。4、HD组患者经治疗后第1、3、5、7d Scr及Urea呈进行性下降并尿量逐渐增多，P＜0.05，有统计学意义。5、动态观察治疗7d，，HP联合PE组患者的AST、ALT下降程度明显优于常规治疗组及HP组，HP组患者的AST、ALT下降程度优于常规治疗组，HP联合PE组患者的TB水平较HP组下降明显，HP联合PE治疗对纠正患者的PT-T、APTT的延长较单纯HP治疗显效快，P＜0.05，以上均有统计学意义。6、HD、HP、HP联合PE治疗PMP的过程中可出现一定程度的并发症。结论：HD治疗利于恢复PMP致急性肾损伤患者的肾功能。HP联合PE治疗在改善PMP患者肝功能方面优于单纯HP治疗和常规药物治疗，并可在早期纠正患者凝血功能的异常，对凝血功能异常的纠正较单纯HP治疗明显。
[Abstract]:Objective: To study the clinical data of 71 cases of poisoning (PMP) in the second hospital of Dalian Medical University, and to discuss the blood dialysis (HD), hemoperfusion (HP) and blood perfusion combined with plasma exchange (Plasma Exchange, The clinical effect of PE in the treatment of PMP can provide more theoretical basis for the clinical optimization of the PMP. Methods: The clinical data of 71 patients with one or more of the liver, the kidney, the blood coagulation and the nervous system in the second hospital of Dalian Medical University from June 1997 to September 2013 were analyzed retrospectively. Materials. According to PMP patients, different treatment methods were divided into: routine treatment group: (drug treatment), total of 19; HD group: (conventional treatment + HD), total of 12; HP group: (conventional treatment + HP), total of 23; HP combined PE group: (conventional treatment + HP + PE), total 17 In the HD group, only the kidney was damaged, the liver, the blood coagulation and the nervous system were damaged, and the patients with HD group were observed to be admitted to the first day, the 3rd day, the 5th day, the 7th day of the blood myotomy (Sdr), the urea (Urea) and the urine volume, and the changes of the Scr, Urea and the urine volume of the patients in different time periods were compared. In the normal treatment group, HP group and HP combined PE group had different degrees of liver, blood coagulation, nervous system damage, no kidney damage, and the three groups of patients were observed to be admitted to the day 1d, 3d, 5d, 7d, and the aspartate aminotransferase (AST), glutamic-pyruvic transaminase (ALT) and total bilirubin (TB) were observed. ), prothrombin time (PT-T), activated partial thromboplastin time (APTT), and the change of AST, ALT, TB, PT-T and APTT in the three groups. Status. Summary of the number and occurrence of associated complications (nausea, vomiting, hypotension, allergic reaction, coagulation, muscle spasms) in the treatment of the PMP using the combination of HD, HP, and HP Rate. The system evaluated the clinical treatment of HD, HP, and HP combined with PE in the treatment of PMP The results showed that all the data were analyzed by SPSS19.0 software, the standard was 0.05, P> 0.05, there was no statistical difference, P <0.05, there was no statistical difference between P <0.05, and the measurement data were expressed by mean and standard deviation (Mean-SD). The comparison of the same group of data before and after the treatment was t-test. One-factor analysis of variance was taken for the comparison between the treatment groups, and the frequency and rate of the counting data indicated that the comparison between the counting data and the counting data was X2 test. Results:1. The age, sex, food poisoning (PM) of HP group, HP group and HP combined PE group were more than the first time of treatment, P> 0.05, no statistical difference. In the 12 cases, there were 10 cases of medium-toxic liver injury + diffuse intravascular coagulation (DIC),7 cases of medium-toxic liver injury,7 cases of medium-toxic encephalopathy,4 cases of toxic and liver injury, and 4 cases of toxic encephalopathy in DIC +. 1 case with toxic hepatic injury + 1 case of toxic encephalopathy and 2 cases of death; in HD group, there were 12 cases of acute renal injury and no death; in the HP group, there were 15 cases of acute renal injury,3 cases of toxic and liver injury,3 cases of toxic hepatic encephalopathy, and 2 cases of toxic liver injury + DI. 3 cases of toxic hepatic injury,2 cases of toxic and hepatic encephalopathy,3 cases of death,3 cases of toxic and liver injury in HP combined PE group,3 cases of toxic and liver injury,3 cases of toxic hepatic encephalopathy,2 cases of toxic and liver injury,2 cases of toxic encephalopathy in DIC +, and no death. 4. The level of AST and ALT in the patients with HD group decreased gradually and the amount of urine increased gradually, P <0.05, there was statistical significance.5. The level of AST and ALT in the patients treated with the combination of HP and HP was better than that of the conventional treatment group and the HP group. The decrease of AST and ALT was better than that of the conventional treatment group, and the level of TB in the HP combined PE group was lower than that in the HP group. The prolongation of the PT-T and APTT of the HP combined PE group was faster than that of the HP group. HP and HP combined with PE can show some degree in the process of PMP Complications. Conclusion: HD therapy is beneficial to the recovery of PMP-induced acute kidney injury. The function of HP combined with PE in improving the liver function of PMP patients is superior to that of simple HP treatment and conventional drug treatment, and the abnormal blood coagulation function can be corrected in the early stage, and the correction of the abnormal blood coagulation function is simple H.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R595.7

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