三种血液净化方式联合治疗20例急性砷化氢中毒疗效观察

发布时间：2018-04-30 19:44

本文选题：血液净化 + 联合治疗　；参考：《环境与职业医学》2017年04期

【摘要】：[目的]观察三种血液净化方式联合治疗急性砷化氢中毒患者的疗效。[方法]昆明医科大学第一附属医院2002—2011年20例急性砷化氢中毒患者,经基础治疗后,应用血浆置换(PE)、联合血液灌流(HP)及连续静脉静脉血液滤过(CVVH)治疗,观察治疗前后临床表现及实验室指标。[结果]20例急性砷化氢中毒患者在入院前均出现了畏寒、发热、头痛、乏力、腰背部酸痛、巩膜皮肤黄染、贫血等症状及不同程度血红蛋白尿,经治疗4~12 d后上述症状及体征减轻直至消失。入院时血红蛋白下降(104.0 g/L),丙氨酸转氨酶、天门冬氨酸转氨酶、肌酸激酶、乳酸脱氢酶、总胆红素、非结合胆红素、结合胆红素、肌酐和尿素氮均升高(分别为104.1、101.5、251.5、1 802.5 U/L,96.0、82.5、13.1、168.7μmol/L,13.3 mmol/L);治疗第3天,总胆红素、非结合胆红素明显下降至29.1和16.3μmol/L;治疗第10天,红细胞和血红蛋白低于正常值下限,丙氨酸转氨酶和肌酐高于正常值上限,总胆红素、非结合胆红素、天门冬氨酸转氨酶、肌酸激酶、乳酸脱氢酶、尿素氮均恢复正常。透析液和尿液中的砷质量浓度在治疗后第3天恢复正常。6周随访时,所有实验室指标恢复正常。[结论]PE、HP及CVVH联合治疗对急性砷化氢中毒有较好的疗效。
[Abstract]:[objective] to observe the therapeutic effect of three blood purification methods on patients with acute hydrogen arsenide poisoning. [methods] Twenty patients with acute hydrogen arsenide poisoning from 2002 to 2011 in the first affiliated Hospital of Kunming Medical University were treated with plasmapheresis combined with hemoperfusion and continuous venous hemofiltration (CVVH) after basic treatment. The clinical manifestations and laboratory indexes were observed before and after treatment. [results] Twenty patients with acute hydrogen arsenide poisoning had symptoms of chills, fever, headache, fatigue, waist and back soreness, scleral skin yellow stain, anemia and hemoglobinuria before admission. After 4 days of treatment, the above symptoms and signs were alleviated until they disappeared. On admission, hemoglobin decreased by 104.0 g / L, alanine aminotransferase, aspartate aminotransferase, creatine kinase, lactate dehydrogenase, total bilirubin, unconjugated bilirubin, conjugated bilirubin, Creatinine and urea nitrogen were increased (104.1101.5 / 251.5U / L 802.5 U / L 96.0 / 82.5g / L 13.1168.7 渭 mol / L / L, 13.3 mmol / L / L respectively; on the third day of treatment, total bilirubin and unconjugated bilirubin decreased significantly to 29.1 渭 mol / L and 16.3 渭 mol / L, respectively; on the 10th day of treatment, red blood cell and hemoglobin were below the lower limit of normal value, and the total bilirubin and unconjugated bilirubin decreased significantly to 29.1 and 16.3 渭 mol / L respectively. Total bilirubin, unconjugated bilirubin, aspartate aminotransferase, creatine kinase, lactate dehydrogenase and urea nitrogen all returned to normal. The concentration of arsenic in dialysate and urine returned to normal at the 3rd day after treatment. [conclusion] the combination therapy of PETHP and CVVH has better curative effect on acute hydrogen arsenide poisoning.
【作者单位】：昆明医科大学第一附属医院急诊科;云南省祥鹏航空公司;
【分类号】：R595

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