不同血液净化方式对砷化氢中毒肾脏损伤预后的影响  

Effects of different blood purification modalities on prognosis of renal damage induced by arsine poisoning

作　　者：谢曼丽 杜永锋 蒋红利[2] XIE Man-Li;DU Yong-Feng;JIANG Hong-Li(Occupational Disease Branch,Xi＇an Central Hospital Xi＇an 710003,China,2Blood Purification Department,The First Affiliated Hospital of Xi＇an Jiaotong Univer-sity,Xi＇an 710061,China)

机构地区：[1]西安市中中心医院职业病科,西安710003 [2]西安交通大学第一附属医院血液净化科,西安710061

出　　处：《中国血液净化》2018年第9期583-587,共5页Chinese Journal of Blood Purification

摘　　要：目的探讨连续性静脉-静脉血液滤过(continuous venous-venous blood filtration,CVVH)与血液透析(hematodialysis,HD)配合血液灌流(blood perfusion,HP)在砷化氢中毒患者中的应用效果及对肾脏损伤预后的影响。方法将入院接受治疗的40例砷中毒患者均分为2组,对照组在常规治疗基础上采用HD+HP进行血液净化治疗;观察组则选择CVVH+HP进行治疗。记录2组临床症状消退、血液净化及住院时间;对比入院时及治疗后2组溶血指标及肾功能指标变化;测定2组入院及治疗3d透析液及尿砷含量。结果与对照组比,观察组平均血液净化时间(t=13.836,P=0.003)、血红蛋白尿(t=7.381,P=0.041)、发热畏寒(t=9.029,P=0.034)、黄疸(t=7.903,P=0.039)、乏力腰背痛(t=9.623,P=0.022)等临床症状消退及住院时间(t=18.349,P=0.001)均明显缩短。治疗1d血清血红蛋白(hemoglobin,Hb)含量下降,第3d开始回升;血清总胆红质(total bilirubine tbil,TBIL)在治疗后持续下降,血肌酐(serum creatinine,Scr)、尿素氮(urea nitrogen,BUN)第1d明显升高,之后持续下降。方差分析显示,上述4项检测指标在入院时及治疗后4个时间点的差异具有显著意义(Hb:F=18.591,P=0.006;TBIL:F=71.855,P<0.001;Scr:F=154.622,P=<0.001;BUN:F=17.728,P=0.011)。治疗后4个时间点血清TBIL(对照组t=7.664、6.722、6.330、12.684,P=0.017、0.021、0.024、0.006;观察组t=8.338、12.564、14.629、7.188,P=0.014、0.006、0.005、0.019)、Hb(对照组t=4.382、4.168、4.496、-4.779,P=0.048、0.044、0.047、0.041;观察组t=6.416、4.512、4.408、5.081,P=0.023、0.046、0.049、0.041)、Scr(对照组t=-11.680、-12.665、-5.768、-9.846,P=0.007、0.006、0.033、0.010;观察组t=-8.526、-12.814、-10.596、17.928,P=0.013、0.006、0.009、0.003)、BUN(对照组t=-4.575、-4.509、4.826、6.646,P=0.045、0.046、0.042、0.031;观察组t=-4.552、5.778、6.269、6.744,P=0.046、0.043、0.040、0.032)水平与入院时比差异均存在显著意义,且治疗后观察组各时间点Objective To investigate the effects of continuous venous-venous hemofiltration（CVVH） and hemodialysis（HD） combined with hemoperfusion（HP） on the prognosis of renal injury in patients with arsine poisoning. Methods A total of 40 patients with arsine poisoning treated in the hospital were divided into two groups： control group treated with HD＋HP and observation group treated with CVVH＋HP in addition to routine management. The duration of clinical symptoms, blood purification and hospitalization were record. The changes of hemolysis and renal function indices, and the arsine content in dialysate and urine at the time of admission and after the treatment were compared between the two groups. Results The average duration of blood purification（t=13.836, P=0.003）, hemoglobinuria（t=7.381, P=0.041）, fever and chills（t=9.029, P=0.034）, jaundice（t=7.903, P=0.039）, fatigue, back pain and other clinical symptoms（t=9.623, P=0.022） and hospitalization（t=18.349, P=0.001） were significantly shortened in observation group as compared with those in control group. Serum Hb content decreased after the treatment for one day, and began to rise after the treatment for 3 days. Serum total bilirubin（TBIL） decreased continuously after the treatment. Serum creatinine（Scr） and BUN increased at the first treatment day and then decreased continuously. Analysis of variance showed that the values of serum HB, TBIL, Scr and BUN at the admission were significantly different from those at the 4 time points after the treatment（F=18.591, P=0.006 for serum HB; F=71.855, P〈0.001 for serum TBIL; F=154.622, P〈0.001 for Scr; F=17.728, P=0.011 for BUN）. At the 4 time points after the treatment, the values of serum TBIL, serum HB, Scr and BUN in both control group and observation group were significantly different as compared with those at the admission（for serum TBIL： t=7.664, 6.722, 6.330 and 12.684, P=0.017, 0.021, 0.024 and 0.006 in control group; t=8.338, 12.564, 14.629 and 7.188, P=0.014,

关 键 词：砷化氢中毒/血液净化 血流灌注 连续性静脉-静脉血液滤过 血液透析 肾损伤 

分 类 号：R459.5[医药卫生—治疗学]