血浆置换治疗以肝脏损害为突出表现的儿童鱼胆中毒  

Application of plasma exchange therapy to treat fish bile poisoning in children with hepatic damage

作　　者：陈光明[1,2,3,4] 陈秀丽[2] 王承峰[1] 李媛媛[1] 陈丽[1] 翁增凤 陈锦华[1] 唐海霞[1] 

机构地区：[1]南京军区福州总医院,福建350025 [2]福建中医药大学福总教学医院 [3]福建医科大学福总临床医学院 [4]厦门大学附属东方医院儿科

出　　处：《中国急救复苏与灾害医学杂志》2016年第4期373-376,共4页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的探讨血浆置换（PE）治疗儿童鱼胆中毒的疗效及安全性。方法11例以肝脏损害为突出表现的鱼胆中毒儿童，在常规对症治疗的基础上，于人院后2—20h后给予PE治疗；观察PE治疗前后临床症状及生命体征变化，并于PE前、PE后、PE后3d、PE后7d抽取静脉血监测血生化改变。结果11例患儿经PE治疗后临床症状很快消失；PE治疗过程中患儿平均动脉压（MAP）、心率（HR）、呼吸频率（RR）和脉搏血氧饱和度（SpO：）等生命体征持续稳定；PE治疗前后各时间点丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、总胆红素（TB）、直接胆红素（DB）、血尿素氮（BUN）、血肌酐（SCR）、肌酸磷酸激酶（CK）、心肌型肌酸激酶同功酶（CK—MB）、乳酸脱氢酶（LDH）、α-羟丁酸脱氢酶（HBD）值存在统计学差异（P〈13．05）；结论PE治疗儿童鱼胆中毒安全有效，早期PE治疗可提高鱼胆中毒儿童的抢救成功率。Objective To investigate the efficacy and safety of plasma exchange （PE） to treat fish bile poisoning in children. Methods A total of 11 children suffering from fish bile poisoning were included in the current study. All patients presented obvious hepatic damage and were provided with PE therapy 2 to 20 h after admission in addition to routine therapy to relieve symptoms. Then, clinical symptoms and vital sign changes were observed before and after PE therapy. Meanwhile, venous blood samples were collected from those children before PE treatment, immediately after PE treatment, 3 d after PE treatment and 7 d after PE treatment to monitor biochemical changes. Results After PE treatment, clinical symptoms quickly disappeared in those children. During PE treatment, these patients presented stable mean arterial pressure （MAP）, heart rate （HR）, respiratory rate （RR） and saturation of pulse oximetry （SpO2） and other vital signs. Statistical differences exist in the levels of alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, total bilirubin （TB）, direct bilirubin （DB）, blood urea nitrogen （BUN）, serum creatinine （SCR）, creatine kinase （CK）, cardiac muscular kinase isoenzyme （CK-MB）, lactate dehydrogenase （LDH） and a-hydroxybutyrate dehydrogenase （HBD） at different time points before and after PE treatment （P 〈0.05）. Conclusion PE therapy is safe and effective for treatment of children suffering from fish bile poisoning. Early PE treatment will improve the success rate of rescue.

关 键 词：鱼胆中毒 儿童 治疗 血浆置换 

分 类 号：R720.597[医药卫生—急诊医学]