杂合式血液净化治疗急性砷化氢中毒的研究  

The efficacy of hybrid blood purification models for the acute hydrogen arsenide poisoning： retrospective clinical trial

作　　者：李洋平 柏明[1] 马峰[1] 于艳[1] 周美兰[1] 王汉民[1] 孙世仁[1] 黄晨[1] 

机构地区：[1]第四军医大学西京医院肾脏内科,西安710032

出　　处：《中华急诊医学杂志》2015年第11期1220-1224,共5页Chinese Journal of Emergency Medicine

摘　　要：目的 探讨不同血液净化方式对急性砷化氢中毒的治疗效果.方法 对2013年1月至2015年1月,收治西京医院急救中心砷化氢中毒患者6例,男性2例,女性4例,平均43.5岁（39 ～50岁）,在对症支持治疗的同时,分别采用血浆置换、血液灌流、血浆吸附及连续性静脉静脉血液滤过（CVVH）的血液净化治疗方法,观察不同血液净化方式对急性砷化氢中毒的治疗作用.结果 在对症支持治疗基础上行血浆置换、血液灌流、血浆吸附及CVVH治疗.其中,4例患者各接受了1次血浆吸附,5例患者各接受了2～6次血浆置换,5例患者各接受了3次血液灌流及3～557.5 h的CVVH.3例轻症患者存活.3例重症患者中,2例分别于中毒后ld、7d死亡,1例中毒后60 d猝死.结果显示血浆吸附、血浆置换及CVVH对血浆中砷浓度都有降低作用,与基线相比,治疗后血浆砷浓度分别下降了31.88％、17.78％和5.5％,血液灌流对血浆砷无清除作用.血液灌流、血浆置换及CVVH对血浆游离血红蛋白有明显清除作用,治疗后血浆游离血红蛋白分别下降了5.14％、25.32％、10.82％.血浆吸附对游离血红蛋白无影响.结论 中毒早期血浆吸附、血浆置换对砷化氢的清除具有一定作用,加以多次的血浆置换及持续的CVVH对不溶性溶血碎片及游离血红蛋白的清除,可起到明显的保护肾功能、促进肾功恢复的作用.Objective To evaluate the efficacy of different blood purification models assorted for acute hydrogen arsenide poisoning.Methods A total of 6 patients with acute hydrogen arsenide poisoning admitted in the emergency center of Xijing hospital between Jan 2011 and Jan 2015 were consecutively enrolled.Of the 6 patients, 4 were female and 2 were male.The mean age was 43.5 years ranged from 39 to 50 years.Besides supportive treatment, all patients were treated with various techniques of blood purification including plasma exchange, hemoperfusion, plasma adsorption, and continuous venovenous hemofiltration （CVVH） prescribed which were selectively employed by the attending physicians.The efficacy of these different blood purification models assorted on blood arsenic and patient outcome were evaluated.Results Four patients had plasma adsorption once, 5 patients accepted plasma exchange twice to 6 times, 5 patients had hemoperfusion thrice combined with 3-557.5 hours of CVVH.Three patients with mild hydrogen arsenide poisoning were alive without obvious sequelae and discharged.The remaining three patients with severe poisoning died at 1 day, 7 days, and 60 days during their hospital stay, respectively.Plasma adsorption, plasma exchange, and CVVH reduced the serum arsenic concentrations by 31.88%, 17.78%, and 5.5%, respectively.Hemoperfusion did not change the serum arsenic concentration.Additionally, hemoperfusion, plasma exchange, and CVVH obviously reduced the free hemoglobin concentrations by 5.14%, 25.43%, and 10.82%, respectively.Plasma adsorption had no effect on serum free hemoglobin concentration.Conclusions Early plasma adsorption and plasma exchange could effectively decrease the serum arsenic concentration.And the addition of multiple plasma exchanges and CVVH could reduce the free hemoglobin concentration benefiting the kidney function.

关 键 词：砷化氢 血浆置换 血浆吸附 连续性静脉静脉血液滤过 血液灌流 中毒 

分 类 号：R595.4[医药卫生—内科学]