血液灌流治疗药物中毒的临床疗效研究  

The clinical efficacy of hemoperfusion in treatment of drug poisoning

作　　者：陈芝[1] 王汉斌[1] 杨红军[1] 邱泽武[1] 丁日高[2] 黄韶清[1] 

机构地区：[1]军事医学科学院附属医院全军中毒救治专科中心,北京100039 [2]军事医学科学院毒物药物研究所

出　　处：《中华内科杂志》2004年第8期611-613,共3页Chinese Journal of Internal Medicine

摘　　要：目的 探讨血液灌流(HP)对急性药物中毒患者血中毒物的清除作用及临床疗效。方法 收集我院1990年7月～2003年12月住院的鼠药(主要为毒鼠强,四亚甲基二砜四胺)和部分药物中毒患者69例,其中34例按常规给予洗胃、保肝、利尿或呼吸支持等综合治疗(非HP组),35例在综合治疗基础上同时给予HP。并用定量方法分析灌流前后患者血中药物浓度。通过观察灌流前后血中药物浓度的变化、生存率、昏迷患者清醒时间、抽搐完全停止时间及病程等几项指标来判断HP的临床疗效。结果 HP组35例中死亡3例,生存率91.4％,非HP组34例中死亡5例,生存率85.3％(P>0.05)。HP组病程明显缩短(P<0.05)。HP后患者意识转清醒及抽搐停止时间较非HP组显著提前。通过对清除率的计算发现:不同药物的清除效果有差异,其中氮革类清除效果好,清除率为(91.6±12.5)％。结论 HP能不同程度清除体内毒物,可明显缩短病程、减少并发症,对于急性重度中毒可望提高生存率。Objective To investigate the ability of hemoperfusion to remove some drugs or toxin from the body and its clinical efficacy. Methods Sixty-nine cases of poisoning due to tetramine or other drugs poisoning in our hospital between July 1990 and December 2003 were studied. Thirty-four patients among them received conventional treatment (including early gastric lavage, hepatoprotection, diuresis or respiratory support ) , and the remaining were given conventional treatment and hemoperfusion. Toxin concentration changes in blood before and after hemoperfusion, survival rate, time from come onset to regaining consciousness and convulsion termination and duration of clinical course were compared. Results In the hemoperfusion group, three patients died, the survival rate was 91.4%, whereas in the non-hemoperfusion group, the survival rate was 85. 3% (P >0. 05). Meanwhile the clinical course was markedly shortened in the hemperfusion group ( P < 0. 05). The time from coma onset to regaining consciousness and convulsion termination in the hemoperfusion group was significantly shorter than that in the non-hemoperfusion group. The clearance rate was different for different poisons, among them the benzodiazepines had an excellent clearance. Conclusions Hemoperfusion could adsorb from blood a different amount of poisons . There is obvious efficacy in shortening clinical course and reducing complications. It could possibly raise survival rate in serious poisoning.

关 键 词：血液灌流 药物中毒 综合治疗 血药浓度 

分 类 号：R595.4[医药卫生—内科学]