血液灌流联合二巯基丙磺酸钠、大剂量维生素B_(6)治疗轻中度急性砷化氢中毒心血管损害的临床研究  

Hemoperfusion Combined with Sodium Dimercaptopropane Sulfonate and VitB_(6) in the Treatment of Patients with Acute Hydrogen Arsenide Poisoning Complicated with Cardiovascular Damage

作　　者：梁博文 何智林 王海清 邓成林 唐新华 LIANG Bowen;HE Zhilin;WANG Haiqing;DENG Chenglin;TANG Xinhua(West China Guang′an Hospital,Sichuan University,Guang′an 638000,Sichuan,China)

机构地区：[1]四川大学华西广安医院,四川广安638000

出　　处：《中西医结合心脑血管病杂志》2022年第9期1622-1626,共5页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

摘　　要：目的观察血液灌流联合二巯基丙磺酸钠+大剂量维生素B_(6)(VitB_(6))治疗轻中度急性砷化氢中毒心血管损害的临床疗效。方法回顾性分析2005年1月—2020年10月58例轻中度急性砷化氢中毒病人的临床资料,根据治疗方案不同分为观察组(32例)和对照组(26例),对照组在基础治疗的基础上予以二巯基丙磺酸钠+大剂量VitB_(6)治疗,观察组在对照组基础上进行血液灌流治疗。比较两组治疗前、治疗1 d、治疗3 d、治疗7 d、治疗10 d尿砷水平、溶血指标及心肌酶指标变化,记录两组典型症状或临床指标恢复时间、临床转归及治疗相关不良反应。结果治疗1 d、3 d、7 d、10 d时,两组尿砷水平均较治疗前明显下降(P<0.05),且观察组同时间尿砷水平低于对照组(P<0.05)。治疗1 d、3 d、7 d、10 d时两组血红蛋白(Hb)呈先降低后升高趋势,血清总胆红素(TBIL)、网织红细胞(Ret)呈逐步降低趋势,且观察组同时间Hb、TBIL均明显低于对照组(P<0.05),但两组Ret水平同时间比较差异无统计学意义(P>0.05)。治疗1 d、3 d、7 d、10 d时,两组血清天冬氨酸氨基转移酶(AST)、肌酸激酶(CK)、乳酸脱氢酶(LDH)均呈逐渐降低趋势,且观察组同时间AST、CK、LDH水平均明显低于对照组(P<0.05)。观察组胸闷/心悸、头痛/乏力症状缓解时间及血红蛋白尿、心电图、心肌酶恢复正常时间均明显短于对照组(P<0.05)。两组均无死亡病例,且未见严重影响治疗不良反应。结论轻中度急性砷化氢中毒心血管损害病人采用血液灌流联合二巯基丙磺酸钠+大剂量VitB_(6)治疗,有助于砷快速清除,减轻病人溶血及心肌损伤,对促进病人症状及临床指标早期恢复有积极意义。Objective To observe the therapeutic value of hemoperfusion combined with sodium dimercaptopropane sulfonate and vitamin B_(6)(VitB_(6))in acute hydrogen arsenide poisoning complicated with cardiovascular damage.Methods The clinical data of 58 patients with mild-to-moderate acute hydrogen arsenide poisoning from January 2005 to October 2020 were retrospectively analyzed.According to the different treatment regimens,the patients were divided into observation group(32 cases)and control group(26 cases).The patients in control group were given sodium dimercaptopropane sulfonate and high-dose VitB_(6) on the basis of basic treatment,and patients in observation group were treated with hemoperfusion on the basis of control group.The changes of urine arsenic level,hemolysis indicators,and myocardial enzyme indicators were compared between two groups was before treatment and at 1 d,3 d,7 d,and 10 d after treatment.The recovery times of typical symptoms or clinical indicators,clinical outcomes,and treatment-related adverse reactions were recorded.Results At 1 d,3 d,7 d,and 10 d after treatment,the urine arsenic level of two groups was significantly lower than that before treatment(P<0.05),and the urine arsenic level of observation group was lower than that of control group at the same time point(P<0.05).At 1 d,3 d,7 d,and 10 d after treatment,the hemoglobin(Hb)of two groups decreased first and then increased,and the total bilirubin(TBIL),Ret decreased gradually,and the Hb and TBIL of observation group were significantly lower than those of control group at the same time point(P<0.05),but there was no significant difference in Ret level between two groups at the same time point(P>0.05).At 1 d,3 d,7 d,and 10 d after treatment,the levels of aspartic transaminase(AST),creatine kinase(CK),and lactic dehydrogenase(LDH)of two groups was decreased gradually,and the levels of AST,CK,and LDH of observation group were significantly lower than those of control group at the same time point(P<0.05).The relief times of symptoms of chest

关 键 词：急性砷化氢中毒 心血管损害 血液灌流 二巯基丙磺酸钠 维生素B_(6) 尿砷 心肌酶 

分 类 号：R595[医药卫生—内科学]