血浆置换治疗急性白毒伞中毒65例临床分析  

Clinical analysis of plasmapheresis in the treatment of acute amanita poisoning: a report of 65 cases

作　　者：陈运超[1] 李婉媚[2] 李小强[1] 

机构地区：[1]广州市第十二人民医院重症医学科,广东广州510620 [2]广州市第十二人民医院内二科,广东广州510620

出　　处：《海南医学》2013年第7期954-956,共3页Hainan Medical Journal

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

摘　　要：目的总结急性白毒伞中毒患者的临床表现,并观察应用血浆置换治疗的临床效果。方法回顾性分析65例急性白毒伞中毒患者的临床表现,比较传统血液净化与血浆置换治疗前后患者的血液和脑脊液中的α-鹅膏毒肽的浓度变化。结果患者在食用食蕈后6~12h出现系列临床症状,大部分出现胃肠炎症状,53例重症。所有患者均出现谷丙转氨酶（ALT）,谷草转氨酶（AST）活性增强,直接和间接胆红素增高。血浆置换组患者脑脊液和血液中α-鹅膏毒肽浓度下降明显高于传统血液净化组（P〈0.01）,且血浆置换组第二疗程治疗效果好于第一疗程（P〈0.01）。结论以血浆置换为主的综合血液净化治疗可有效降低急性白毒伞中毒患者的毒肽水平,提高抢救成功率,改善患者预后。Objective To summarize the clinical manifestations of acute amanita poisoning, and to observe the clinical effect of plasmapheresis in the treatment of acute amanita poisoning. Methods The clinical manifestations of 65 cases of acute amanita poisoning were retrospectively analyzed. The changes of α-amatoxins levels in the blood and the cerebrospinal fluid were compared before and after traditional blood purification and plasmapheresis. Results The patients showed a series of clinical symptoms 6~12 h after consumption of white phalloidin, and most of patients were found with symptoms of gastroenteritis, with 53 cases of severe symptoms. The activity of alanine aminotransferase （ALT） and aspartate aminotransferase （AST） increased, and the direct and indirect bilirubin increased proportionally after 6~12 h. The decline of α-amatoxins in the plasmapheresis group was significantly more profound than the traditional blood purification （P〈0.01）. In the plasmapheresis group, the second course of treatment had better therapeutic effect than the first course. Conclusion Plasmapheresis can effectively decline the levels of α-amatoxins in patients with acute amanita poisoning, improve the success rate and the prognosis.

关 键 词：白毒伞中毒 血浆置换 α-鹅膏毒肽 

分 类 号：R595.7[医药卫生—内科学]