不同的血液凈化療法治療毒蕈中毒的臨床療效評價(jià)
發(fā)布時間：2019-05-18 11:11
【摘要】：目的：通過回顧性分析大連醫(yī)科大學(xué)附屬第二醫(yī)院收治的71例毒蕈中毒（poisonous mushroom poisoning，PMP）患者的臨床資料，探討血液透析（Hemodialysis，HD）、血液灌流（Hemoperfusion，HP）、血液灌流聯(lián)合血漿置換（Plasma Exchange，PE）在治療PMP中的臨床療效，為臨床中優(yōu)化治療PMP提供更多的理論依據(jù)。 方法：通過回顧性分析1997年06月至2013年09月期間大連醫(yī)科大學(xué)附屬第二醫(yī)院收治的因PMP導(dǎo)致肝臟、腎臟、凝血、神經(jīng)系統(tǒng)中存在一種或多種系統(tǒng)受損的71例患者的臨床資料。依據(jù)PMP患者接受不同的治療方法分為：常規(guī)治療組：（藥物治療），共19例；HD組：（常規(guī)治療+HD），共12例；HP組：（常規(guī)治療+HP），共23例；HP聯(lián)合PE組：（常規(guī)治療+HP+PE），共17例。HD組患者僅出現(xiàn)腎臟受損，無肝臟、凝血、神經(jīng)系統(tǒng)受損，動態(tài)觀察HD組患者入院第1d、3d、5d、7d的血肌酐（Scr）、血尿素（Urea）及尿量，自身對比在不同時間段內(nèi)患者Scr、Urea及尿量的變化情況。常規(guī)治療組、HP組、HP聯(lián)合PE組患者均出現(xiàn)不同程度的肝臟、凝血、神經(jīng)系統(tǒng)受損，無腎臟受損，動態(tài)觀察三組患者入院第1d、3d、5d、7d的谷草轉(zhuǎn)氨酶（AST）、谷丙轉(zhuǎn)氨酶（ALT）、總膽紅素（TB）、凝血酶原時間（PT-T）、活化部分凝活酶時間（APTT），比較三組患者在治療不同時間段AST、ALT、TB、PT-T、APTT的變化情況�？偨Y(jié)應(yīng)用HD、HP、HP聯(lián)合PE在治療PMP過程中出現(xiàn)的相關(guān)并發(fā)癥（惡心、嘔吐、低血壓、過敏反應(yīng)、凝血、肌肉痙攣）的次數(shù)及發(fā)生率。系統(tǒng)評價(jià)HD、HP、HP聯(lián)合PE在治療PMP中的臨床療效。所有數(shù)據(jù)均采用SPSS19.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析，標(biāo)準(zhǔn)為0.05，P＞0.05無統(tǒng)計(jì)學(xué)差異，P＜0.05有統(tǒng)計(jì)學(xué)差異；計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差（Mean±SD）表示，同組資料治療前后的對比采取配對樣本均數(shù)t檢驗(yàn)，多個治療組間的比較采取單因素方差分析；計(jì)數(shù)資料用頻數(shù)及率表示，計(jì)數(shù)資料間的比較采用X2檢驗(yàn)。 結(jié)果：1、常規(guī)治療組、HD組、HP組、HP聯(lián)合PE組患者的年齡、性別、食用毒蕈（poisonous mushroom，PM）至首次就診時間的比較，P＞0.05，無統(tǒng)計(jì)學(xué)差異。2、71例PMP患者并發(fā)中毒性肝損傷38例、急性腎損傷12例、中毒性肝損傷+彌漫性血管內(nèi)凝血（Disseminated intravascular coagulation，DIC）10例、中毒性肝損傷+中毒性腦病7例、中毒性肝損傷+DIC+中毒性腦病4例。3、常規(guī)治療組患者并發(fā)中毒性肝損傷17例、中毒性肝損傷+DIC1例、中毒性肝損傷+中毒性腦病1例，死亡2例；HD組患者并發(fā)急性腎損傷12例，無死亡；HP組患者并發(fā)中毒性肝損傷15例、中毒性肝損傷+中毒性腦病3例、中毒性肝損傷+DIC3例、中毒性肝損傷+DIC+中毒性腦病2例，死亡3例；HP聯(lián)合PE組患者并發(fā)中毒性肝損傷6例、中毒性肝損傷+中毒性腦病3例、中毒性肝損傷+DIC6例、中毒性肝損傷+DIC+中毒性腦病2例，無死亡。4、HD組患者經(jīng)治療后第1、3、5、7d Scr及Urea呈進(jìn)行性下降并尿量逐漸增多，P＜0.05，有統(tǒng)計(jì)學(xué)意義。5、動態(tài)觀察治療7d，，HP聯(lián)合PE組患者的AST、ALT下降程度明顯優(yōu)于常規(guī)治療組及HP組，HP組患者的AST、ALT下降程度優(yōu)于常規(guī)治療組，HP聯(lián)合PE組患者的TB水平較HP組下降明顯，HP聯(lián)合PE治療對糾正患者的PT-T、APTT的延長較單純HP治療顯效快，P＜0.05，以上均有統(tǒng)計(jì)學(xué)意義。6、HD、HP、HP聯(lián)合PE治療PMP的過程中可出現(xiàn)一定程度的并發(fā)癥。 結(jié)論：HD治療利于恢復(fù)PMP致急性腎損傷患者的腎功能。HP聯(lián)合PE治療在改善PMP患者肝功能方面優(yōu)于單純HP治療和常規(guī)藥物治療，并可在早期糾正患者凝血功能的異常，對凝血功能異常的糾正較單純HP治療明顯。
[Abstract]:Objective: To study the clinical data of 71 cases of poisoning (PMP) in the second hospital of Dalian Medical University, and to discuss the blood dialysis (HD), hemoperfusion (HP) and blood perfusion combined with plasma exchange (Plasma Exchange, The clinical effect of PE in the treatment of PMP can provide more theoretical basis for the clinical optimization of the PMP. Methods: The clinical data of 71 patients with one or more of the liver, the kidney, the blood coagulation and the nervous system in the second hospital of Dalian Medical University from June 1997 to September 2013 were analyzed retrospectively. Materials. According to PMP patients, different treatment methods were divided into: routine treatment group: (drug treatment), total of 19; HD group: (conventional treatment + HD), total of 12; HP group: (conventional treatment + HP), total of 23; HP combined PE group: (conventional treatment + HP + PE), total 17 In the HD group, only the kidney was damaged, the liver, the blood coagulation and the nervous system were damaged, and the patients with HD group were observed to be admitted to the first day, the 3rd day, the 5th day, the 7th day of the blood myotomy (Sdr), the urea (Urea) and the urine volume, and the changes of the Scr, Urea and the urine volume of the patients in different time periods were compared. In the normal treatment group, HP group and HP combined PE group had different degrees of liver, blood coagulation, nervous system damage, no kidney damage, and the three groups of patients were observed to be admitted to the day 1d, 3d, 5d, 7d, and the aspartate aminotransferase (AST), glutamic-pyruvic transaminase (ALT) and total bilirubin (TB) were observed. ), prothrombin time (PT-T), activated partial thromboplastin time (APTT), and the change of AST, ALT, TB, PT-T and APTT in the three groups. Status. Summary of the number and occurrence of associated complications (nausea, vomiting, hypotension, allergic reaction, coagulation, muscle spasms) in the treatment of the PMP using the combination of HD, HP, and HP Rate. The system evaluated the clinical treatment of HD, HP, and HP combined with PE in the treatment of PMP The results showed that all the data were analyzed by SPSS19.0 software, the standard was 0.05, P> 0.05, there was no statistical difference, P <0.05, there was no statistical difference between P <0.05, and the measurement data were expressed by mean and standard deviation (Mean-SD). The comparison of the same group of data before and after the treatment was t-test. One-factor analysis of variance was taken for the comparison between the treatment groups, and the frequency and rate of the counting data indicated that the comparison between the counting data and the counting data was X2 test. Results:1. The age, sex, food poisoning (PM) of HP group, HP group and HP combined PE group were more than the first time of treatment, P> 0.05, no statistical difference. In the 12 cases, there were 10 cases of medium-toxic liver injury + diffuse intravascular coagulation (DIC),7 cases of medium-toxic liver injury,7 cases of medium-toxic encephalopathy,4 cases of toxic and liver injury, and 4 cases of toxic encephalopathy in DIC +. 1 case with toxic hepatic injury + 1 case of toxic encephalopathy and 2 cases of death; in HD group, there were 12 cases of acute renal injury and no death; in the HP group, there were 15 cases of acute renal injury,3 cases of toxic and liver injury,3 cases of toxic hepatic encephalopathy, and 2 cases of toxic liver injury + DI. 3 cases of toxic hepatic injury,2 cases of toxic and hepatic encephalopathy,3 cases of death,3 cases of toxic and liver injury in HP combined PE group,3 cases of toxic and liver injury,3 cases of toxic hepatic encephalopathy,2 cases of toxic and liver injury,2 cases of toxic encephalopathy in DIC +, and no death. 4. The level of AST and ALT in the patients with HD group decreased gradually and the amount of urine increased gradually, P <0.05, there was statistical significance.5. The level of AST and ALT in the patients treated with the combination of HP and HP was better than that of the conventional treatment group and the HP group. The decrease of AST and ALT was better than that of the conventional treatment group, and the level of TB in the HP combined PE group was lower than that in the HP group. The prolongation of the PT-T and APTT of the HP combined PE group was faster than that of the HP group. HP and HP combined with PE can show some degree in the process of PMP Complications. Conclusion: HD therapy is beneficial to the recovery of PMP-induced acute kidney injury. The function of HP combined with PE in improving the liver function of PMP patients is superior to that of simple HP treatment and conventional drug treatment, and the abnormal blood coagulation function can be corrected in the early stage, and the correction of the abnormal blood coagulation function is simple H.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R595.7
本文編號：2479946
[Abstract]:Objective: To study the clinical data of 71 cases of poisoning (PMP) in the second hospital of Dalian Medical University, and to discuss the blood dialysis (HD), hemoperfusion (HP) and blood perfusion combined with plasma exchange (Plasma Exchange, The clinical effect of PE in the treatment of PMP can provide more theoretical basis for the clinical optimization of the PMP. Methods: The clinical data of 71 patients with one or more of the liver, the kidney, the blood coagulation and the nervous system in the second hospital of Dalian Medical University from June 1997 to September 2013 were analyzed retrospectively. Materials. According to PMP patients, different treatment methods were divided into: routine treatment group: (drug treatment), total of 19; HD group: (conventional treatment + HD), total of 12; HP group: (conventional treatment + HP), total of 23; HP combined PE group: (conventional treatment + HP + PE), total 17 In the HD group, only the kidney was damaged, the liver, the blood coagulation and the nervous system were damaged, and the patients with HD group were observed to be admitted to the first day, the 3rd day, the 5th day, the 7th day of the blood myotomy (Sdr), the urea (Urea) and the urine volume, and the changes of the Scr, Urea and the urine volume of the patients in different time periods were compared. In the normal treatment group, HP group and HP combined PE group had different degrees of liver, blood coagulation, nervous system damage, no kidney damage, and the three groups of patients were observed to be admitted to the day 1d, 3d, 5d, 7d, and the aspartate aminotransferase (AST), glutamic-pyruvic transaminase (ALT) and total bilirubin (TB) were observed. ), prothrombin time (PT-T), activated partial thromboplastin time (APTT), and the change of AST, ALT, TB, PT-T and APTT in the three groups. Status. Summary of the number and occurrence of associated complications (nausea, vomiting, hypotension, allergic reaction, coagulation, muscle spasms) in the treatment of the PMP using the combination of HD, HP, and HP Rate. The system evaluated the clinical treatment of HD, HP, and HP combined with PE in the treatment of PMP The results showed that all the data were analyzed by SPSS19.0 software, the standard was 0.05, P> 0.05, there was no statistical difference, P <0.05, there was no statistical difference between P <0.05, and the measurement data were expressed by mean and standard deviation (Mean-SD). The comparison of the same group of data before and after the treatment was t-test. One-factor analysis of variance was taken for the comparison between the treatment groups, and the frequency and rate of the counting data indicated that the comparison between the counting data and the counting data was X2 test. Results:1. The age, sex, food poisoning (PM) of HP group, HP group and HP combined PE group were more than the first time of treatment, P> 0.05, no statistical difference. In the 12 cases, there were 10 cases of medium-toxic liver injury + diffuse intravascular coagulation (DIC),7 cases of medium-toxic liver injury,7 cases of medium-toxic encephalopathy,4 cases of toxic and liver injury, and 4 cases of toxic encephalopathy in DIC +. 1 case with toxic hepatic injury + 1 case of toxic encephalopathy and 2 cases of death; in HD group, there were 12 cases of acute renal injury and no death; in the HP group, there were 15 cases of acute renal injury,3 cases of toxic and liver injury,3 cases of toxic hepatic encephalopathy, and 2 cases of toxic liver injury + DI. 3 cases of toxic hepatic injury,2 cases of toxic and hepatic encephalopathy,3 cases of death,3 cases of toxic and liver injury in HP combined PE group,3 cases of toxic and liver injury,3 cases of toxic hepatic encephalopathy,2 cases of toxic and liver injury,2 cases of toxic encephalopathy in DIC +, and no death. 4. The level of AST and ALT in the patients with HD group decreased gradually and the amount of urine increased gradually, P <0.05, there was statistical significance.5. The level of AST and ALT in the patients treated with the combination of HP and HP was better than that of the conventional treatment group and the HP group. The decrease of AST and ALT was better than that of the conventional treatment group, and the level of TB in the HP combined PE group was lower than that in the HP group. The prolongation of the PT-T and APTT of the HP combined PE group was faster than that of the HP group. HP and HP combined with PE can show some degree in the process of PMP Complications. Conclusion: HD therapy is beneficial to the recovery of PMP-induced acute kidney injury. The function of HP combined with PE in improving the liver function of PMP patients is superior to that of simple HP treatment and conventional drug treatment, and the abnormal blood coagulation function can be corrected in the early stage, and the correction of the abnormal blood coagulation function is simple H.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R595.7
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