血液灌流在急性2，4-二硝基苯酚中毒治疗中的作用  

Effects of hemoperfusion on the patients with acute toxication of 2,4-dinitrophenoi

作　　者：何永春[1] 张萍[1] 徐春萍[1] 严慧娟[1] 陆远强[1] 蔡增轩[2] 陈江华[1] 

机构地区：[1]浙江大学医学院附属第一医院肾脏病中心,杭州310003 [2]浙江省疾病预防控制中心

出　　处：《中华医学杂志》2013年第34期2742-2744,共3页National Medical Journal of China

基　　金：浙江省科技计划（2007C13055）

摘　　要：目的探讨血液灌流对治疗急性2，4-二硝基苯酚中毒的作用。方法采用自身前后对照的方法，对2009年9月14日我院收治的14例急性2，4-二硝基苯酚中毒患者根据入院时的临床症状分为重度中毒组和轻度中毒组，两组患者均于入院后2h内予血液灌流治疗，观察治疗前后临床症状缓解情况、相关实验室指标变化，用液质联用法检测每次灌流治疗前后血2，4-二硝基苯酚水平变化。所有患者同时予对症和支持治疗。结果重度中毒组患者灌流治疗1次后，临床症状明显缓解，治疗前后2，4-二硝基苯酚水平分别为28．21（15．56—45．23）和16．11（10．10～27．52）mg／L，差异有统计学意义（P〈0．05），但3h后症状反跳，连续治疗3次后主要临床症状缓解无反跳，连续治疗6次，主要临床症状基本消失。轻度中毒组患者治疗2次后临床症状基本消失，无反跳。两组患者均救治成功，中性粒细胞及血小板计数下降，肝酶上升，出院后1及3个月进行随访均无明显后遗症。结论两组患者临床症状的严重程度与毒物浓度呈密切相关，血液灌流能有效清除中毒患者体内的2，4-二硝基苯酚，迅速下降血液毒物浓度，缓解临床症状，提高存活率。Objective To explore the management strategies of acute toxication of 2,4-dinitrophenol by hemoperfusion. Methods A total of 14 patients with acute toxication of 2,4-dinitrophenol were admitted on September 14, 2009. And they were divided into severe and mild groups according to the severify of clinical manifestation. All patients in both groups received 2-hour blood perfusion within 2 hour post- admission. Their clinical manifestations, laboratory parameters and 2,4-dinitrophenol levels were carefully observed before and after each perfusion. And oxygenation, intravenous use of furosemide, corticosteroids and symptomatic therapies were simultaneously given to improve general conditions. Results In serious group, the levels of before and after the first perfusion were 28.21 （ 15.56 - 45. 23 ） and 16. 11 （ 10. 10 - 27.52） mg/L （P 〈 0. 05 ）, respectively. In both groups, all levels of 2,4-dinitrophenol were significantly reduced before and after each perfusion （ all P 〈 0. 05 ）. The patients in severe group would get relieved after 3 vs 2 perfusions in mild group. In severe group, there was a remarked decrease in neutrophil and platelet count after perfusion than those in mild group. The fiver enzymes and blood lipids in both groups after therapy significantly elevated than those before therapy （ all P 〈 0.05 ）. Conclusion Crucial for managing acute toxication of 2,4-dinitrophenol, early hemoperfusion reduces mortality.

关 键 词：血液灌流 2 4-二硝基苯酚 中毒 

分 类 号：R595.4[医药卫生—内科学]