分子吸附再循环系统（MARS）对急性重度肝炎型毒蕈中毒的疗效评价  

Evaluation of molecular absorbent recirculating system （MARS） on acute mushroom poisoning patients with severe toxic hepatitis

作　　者：张聪[1] 黄昌保[1] 白丽娜[1] 江云[1] 张锡刚[1] 孙百胜[1] ZHANG Cong HUANG Chang-bao BAI Li-na JIANG Yun ZHANG Xi-gang SUN Bai-sheng(Department of Emergency, 307 Hospital of PLA, Beijing, 100071, China)

机构地区：[1]中国人民解放军307医院,北京100071

出　　处：《中国急救复苏与灾害医学杂志》2017年第5期430-433,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：国家级项目基金：化学损伤毒物清除技术与核化损伤医学处置关键技术集成（12BA138804）

摘　　要：目的评价分子吸附再循环系统（molecularadsorbentrecirculatingsystem，MARS）对急性重度肝炎型毒蕈中毒的治疗疗效。方法回顾性分析2007年1月-2015年12月解放军307医院重症监护室（emergencvintensivecareunit，EICU）收治的33例急性重度肝炎型毒蕈中毒患者临床病例资料。根据治疗方法不同分为血浆置换治疗组即PE组（基础治疗联合血浆置换治疗）及分子吸附再循环系统治疗组即MARS组（基础治疗联合MARS治疗），比较两组患者谷丙转氨酶、总胆红素、直接胆红素、凝血酶原时间、国际标准化比值、血小板等的变化趋势及肝性脑病发生情况及死亡率。结果MARS组患者ALT、TBIL、DBIL、PLT恢复程度明显优于PE组，PE组患者呈酶-胆分离现象，PT、INR则无明显差异。PE组发生肝性脑病11人（39．3％），死亡9例，肝性脑病的病死率为81．8％，而MARS组发生肝性脑病2人（40．0％），死亡1例，肝性脑病的病死率为50％。结论MARS单独或联合PE治疗重度肝炎型毒蕈中毒患者的疗效优于单独PE及常规药物治疗，并可降低肝性脑病者的病死率。Objective To investigate the efficacy of molecular absorbent recirculating system （MARS） on mushroom poisoning patients with severe toxic hepatitis. Method Retrospective analyze the clinical data of 33 patients of mushroom poisoning with severe toxic hepatitis in 307 hospital of PLA from Jan. 2007 to Dec. 2015. The patients were divided into two groups according to their therapeutic methods： plasma exchange group （PE group） and molecular adsorbent reeirculating system group （MARS group）. The change trend of glutamie-pyruvic transaminase （ALT）, total bilirubin （TBIL）, direct bilirubin （DBIL）, prothrombin time （PT）, international normalized ratio （INR） and thrombocyte （PLT） were compared. The occurrence of hepatic encephalopathy and mortality were also compared. Results The recovery of ALT, TBIL, DBIL and PLT in MARS group patients was significantly superior to PE group patients, while there were no significantly difference in PT and INR between two groups. The ＂bile - enzyme separation phenomenon＂ was present in PE group. 11 patients （39.3%） occurred hepatic encephalopathy in PE group compared to 2 patients （40.0%） in MARS group, the mortalities caused by hepatic eneephalopathy in two groups were 81.8% and 50%. Conclusion The efficacy of MARS is superior to PE in therapy of mushroom poisoning with severe toxic hepatitis, the morbidity of hepatic encephalopathy reduced.

关 键 词：毒蕈中毒 肝性脑病 血浆置换 分子吸附再循环系统 

分 类 号：R516.2[医药卫生—内科学]