血必净联合甲泼尼龙治疗九香虫中毒的临床疗效  

Clinical observation of treating aspongopus poisoning by Xuebijing Injection combined with methylprednisolone

作　　者：徐盈[1] 倪昆[2] 王雷 杨依林 李妮娜 沈源 赵英[5] Xu Ying;Ni Kun;Wang Lei;Yang Yilin;Li Nina;Shen Yuan;Zhao Ying(Daytime Ward Center,2Department of Traditional Chinese Medicine,3Department of Medical Affairs,4Department of Emergency,5Department of MRI,the First People's Hospital of Yunnan Province,Affiliated Hospital of Kunming University of Science and Technology,Kunming 650032,Yunnan,China)

机构地区：[1]云南省第一人民医院日间病房中心,云南昆明650032 [2]云南省第一人民医院中医科,云南昆明650032 [3]云南省第一人民医院医务部,云南昆明650032 [4]云南省第一人民医院急诊科,云南昆明650032 [5]云南省第一人民医院MRI科,云南昆明650032

出　　处：《中国中西医结合急救杂志》2019年第6期694-696,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

摘　　要：目的 观察血必净联合甲泼尼龙救治九香虫中毒的临床疗效.方法 收集2015年7月12至22日云南省第一人民医院急诊科收治的11例九香虫中毒患者,均在常规治疗的基础上将血必净50 mL加入到0.9%生理盐水100 mL中静脉滴注(静滴),每日2次,连续使用7~10 d;同时将甲泼尼龙40 mg加入到0.9%生理盐水50 mL中静脉泵入,每日1次,连用3~5 d.分析患者临床资料和实验室指标测定结果的特点,并比较治疗前后实验室指标变化的差异,评估多器官功能受损修复情况及临床疗效.结果 九香虫中毒患者治疗后实验室检测指标均较治疗前明显降低[肌酸激酶(CK,U/L):177.7±38.2比32 559.0±11 816.0,肌酸激酶同工酶(CK-MB,U/L):121.6±46.9比3 465.0±1 629.0,丙氨酸转氨酶(ALT,U/L):25.0±6.0比1 109.0±467.0,大冬氨酸转氨酶(AST,U/L):23.0±9.0比842.0±427.0,肌红蛋白(Myo,μg/L):103.8±27.9比9 273.0±3 560.0,乳酸脱氢酶(LDH,μmol·s^-1·L^-1):1.75±0.46比17.80±7.20,超敏C-反应蛋白(hs-CRP, mg/L):1.4±1.0比102.0±33.0,降钙素原(PCT,μg/L):0.013±0.014比20.800±7.900,尿素氮(BUN,mmol/L):4.8±1.5比26.8±9.7,肌酥(Cr,μmol/L):56.0±23.0比696.7±92.3,乳酸(Lac,mmol/L):1.20±0.58比10.79± 4.57,均P<0.05];其中6例患者伴急性呼吸窘迫综合征(ARDS),治疗后动脉血氧分压(PaO2)较治疗前明显升高[mmHg (1 mmHg=0.133 kPa):103.60±19.40比54.60±16.20],动脉血二氧化碳分压(PaCO2)较治疗前明显降低(mmHg :32.50±4.60比33.26±6.90),差异均有统计学意义(均P<0.05),恢复时间为(5.7±1.2) d.结论 九香虫中毒患者发病急、症状重,早期即出现急性肌肉损伤以及多器官功能障碍综合征(MODS).血必净联合甲泼尼龙治疗能减少各器官功能损伤,促进各器官功能修复,更有效地缩短病程.Objective To observe the clinical effect of treating patients with aspongopus poisoning by Xuebijing Injection combined with methylprednisolone.Methods Eleven patients with aspongopus poisoning patients were collected in 12-22 July 2015 in the Department of Emergency of First People's Hospital of Yunnan Province.All patients received Xuebijing 50 mL+0.9%normal saline 100 mL intravenous drip,twice a day for continuous 7-10 days;meanwhile,they received methylprednisolone 40 mg+0.9%normal saline 50 mL intravenously pumped,once a day for 3-5 days.The characteristics of patients'clinical data and laboratory indexes determination results were analyzed and summarized and the differences in changes of laboratory indexes before and after treatment were compared to evaluate the repair situations of multiple organ dysfunctions and clinical effect.Results After treatment,the laboratory test results of patients with the aspongopus poisoning were lower than those before treatment[creatine kinase(CK,U/L):177.7±38.2 vs.32559.0±11816.0,creatine kinase isoenzyme(CK-MB,U/L):121.6±46.9 vs.3465.0±1629.0,alanine aminotransferase(ALT,U/L):25.0±6.0 vs.1109.0±467.0,aspartic transferase(AST,U/L):23.0±9.0 vs.842.0±427.0,Myoglobin(Myo,μg/L):103.8±27.9 vs.9273.0±3560.0,lactate dehydrogenase(LDH,μmol·s^-1·L^-1):1.75±0.46 vs.17.80±7.20,hypersensitive C-reactive protein(hs-CRP,mg/L):1.4±1.0 vs.102.0±33.0,procalcitonin(PCT,μg/L):0.013±0.014 vs.20.800±7.900,urea nitrogen(BUN,mmol/L):4.8±1.5 vs.26.8±9.7,creatinine(Cr,μmol/L):56.0±23.0 vs.696.7±92.3,lactic acid(Lac,mmol/L):1.20±0.58 vs.10.79±4.57,all P<0.05];among the patients,6 cases of patients were associated with acute respiratory distress syndrome(ARDS),after treatment the arterial partial pressure of oxygen(PaO2)was increased significantly compared with that before treatment[mmHg(1 mmHg=0.133 kPa):103.60±19.40 vs.54.60±16.20],the partial pressure of arterial carbon dioxide(PaCO2)was significantly lower than that before treatment(mmHg:32.50±4.60 vs.33.26±6.90),t

关 键 词：九香虫 肌酸激酶 肌红蛋白 多器官功能障碍综合征 血必净 糖皮质激素 

分 类 号：R28[医药卫生—中药学]