血液净化治疗在含鹅膏毒肽蕈类中毒致肝衰竭中的作用  

Effect of blood purification therapy on liver failure caused by amatoxin mushroom poisoning

作　　者：马秀英 朱玲[1] 布冰 耿嘉蔚[1] Ma Xiuying;Zhu Ling;Bu Bing;Geng Jiawei(Department of Infectious Diseases and Liver Diseases,the First People's Hospital of Yunnan Province,the Affiliated Hospital of Kunming University of Science and Technology)

机构地区：[1]云南省第一人民医院昆明理工大学附属医院感染疾病科及肝病科,云南昆明000000

出　　处：《中国中西医结合急救杂志》2021年第6期763-766,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：云南省第一人民医院肠道微生态相关疾病机制和转化应用研究省创新团队(202005AE160010);云南(昆明)张文宏专家工作站(YSZJGZZ-20200051);云南省临床病毒学重点实验室(2018DG010)。

摘　　要：含鹅膏毒肽蕈类中毒是蕈中毒死亡最重要的原因之一。鹅膏毒肽致死率高,目前无特效解毒药物,血液净化(非生物型人工肝)治疗在临床应用成熟,在含鹅膏毒肽蕈类中毒致肝衰竭治疗中有一定作用。血液净化治疗模式多样,各种模式的主要功能有所差异。在含鹅膏毒肽蕈类中毒的患者中应用血液净化治疗,需同时依据鹅膏毒肽的毒素特点、特殊的毒代动力学、毒理特点及中毒时间来区别选择。中毒48 h内选择以清除毒素为主要目的血液净化模式,如血液灌流、血浆置换、分子吸附再循环系统(MARS)、成分血浆分离吸附(FPSA)系统。中毒48 h后,根据肝衰竭及其并发症选择恰当的个体化血液净化模式,而联合治疗可能优于单一模式。临床如能合理选择血液净化治疗模式,可为毒蕈中毒有效治疗争取时间、提供桥梁。Amatoxin mushroom poisoning is one of the most important fatal causes of mushroom poisoning.It has high mortality without specific antidote at present.Blood purification/artificial liver support therapy is mature in clinical application,which plays a certain role in the treatment of liver failure caused by amatoxin.There are various modes of blood purification,and the main functions of each mode are different.The application of blood purification therapy in patients with amanita mushroom poisoning should be based on the characteristics of amatoxin,special toxicokinetic,toxicological characteristics,and poisoning time.Within 48 hours after poisoning,the blood purification modes with the main purpose of eliminating toxins should be selected,such as hemoperfusion,plasmapheresis,molecular adsorption recirculation system(MARS),and fractionated plasma separation and adsorption(FPSA)system.After 48 hours of poisoning,the appropriate individualized blood purification modes should be selected according to the liver failure and its complications.The combination therapy may be superior to the single mode.If we choose the treatment mode of blood purification reasonably,it may gain time and provide a bridge for the effective treatment of this kind of poisoning.

关 键 词：鹅膏毒肽蕈中毒 肝衰竭 血液净化治疗 非生物人工肝 

分 类 号：R59[医药卫生—内科学]