血浆置换在急性白毒伞中毒性脑病中的临床应用价值分析  

The clinical value of plasma exchange on the treatment of acute white poison umbrella toxic encephalopathy

作　　者：李婉媚[1] 陈运超[2] 李小强[2] 

机构地区：[1]广州市第十二人民医院内科,广东广州510620 [2]广州市第十二人民医院ICU,广东广州510620

出　　处：《中国现代医生》2012年第32期46-48,共3页China Modern Doctor

基　　金：2011年度广东省广州市医药卫生科技项目(201102A213214);2011年度广东省医学科研基金立项课题(A2011519)

摘　　要：目的分析血浆置换清除毒肽的效果,以及毒肽能否穿透血脑屏障损害神经系统。初步明确白毒伞中毒患者中毒性脑病的发病机制和血浆置换的治疗机制。方法收集2007～2012年临床确诊的急性白毒伞中毒病例40例,应用高效液相色谱技术检测临床病例血浆置换前后血液、尿液、脑脊液以及血浆置换废液中α-鹅膏毒肽、鬼比毒肽的浓度,并同期进行肝肾功能等相关检查。结果治疗后血液、脑脊液中α-鹅膏毒肽浓度均低于治疗前,且第二疗程低于第一疗程,差异有统计学有意义(P<0.05);肝肾功能以及心肌酶谱等指标均明显低于治疗前(P<0.05),且第二疗程低于第一疗程(P<0.05)。结论血浆置换能有效降低急性白毒伞中毒后血液以及脑脊液中毒肽的浓度,保障患者生命安全,是治疗中毒性脑病的急救措施。Objective To analyze whether plasma exchange can really clear phallotoxins or not,and whether phallotoxins can penetrate blood brain barrier or not. Preliminary cleared that white poison umbrella poisoning patients＂ toxic en- cephalopathy＇s pathogenesis and plasma exchange＇s treatment mechanism. Methods Collected 40 cases of those who have been clinical diagnosed as acute white poison umbrella poisoning patients,adopted high-performance liquid chromatogra- phy to test clinical cases＂ blood,urine,cerebrospinal fluid and plasma exchange liquid waste goose paste poison peptide concentration before and after plasma exchange,in the meantime,proceeded hepatorenal function check up for the patients. Results After the treatment,blood, urine and cerebrospinal fluid goose paste poison peptide concentration were lower than before treatment,and the second course was lower than the first one,it had statistics meaning （P 〈 0.05）. Besides hepatore- nal function and myocardial enzyme spectrum out BUN were higher than before treatment,the other indexes were lower than before treatment （P 〈 0.05）,what＇s more,the second course was lower than the first one （P 〈 0.05）. Conclusion Plas- ma exchange can bring down blood,urine and cerebrospinal fluid＇s phallotoxins concentration effectively after the acute white poison umbrella poisoning,and can ensure patients life security,it is the emergency measure for the treatment of toxic encephalopathy.

关 键 词：血浆置换 白毒伞中毒 中毒性脑病 鹅膏毒肽 

分 类 号：R595.7[医药卫生—内科学]