本文選題：血液凈化 + 聯(lián)合治療　； 參考：《環(huán)境與職業(yè)醫(yī)學》2017年04期

【摘要】：[目的]觀察三種血液凈化方式聯(lián)合治療急性砷化氫中毒患者的療效。[方法]昆明醫(yī)科大學第一附屬醫(yī)院2002—2011年20例急性砷化氫中毒患者,經基礎治療后,應用血漿置換(PE)、聯(lián)合血液灌流(HP)及連續(xù)靜脈靜脈血液濾過(CVVH)治療,觀察治療前后臨床表現及實驗室指標。[結果]20例急性砷化氫中毒患者在入院前均出現了畏寒、發(fā)熱、頭痛、乏力、腰背部酸痛、鞏膜皮膚黃染、貧血等癥狀及不同程度血紅蛋白尿,經治療4~12 d后上述癥狀及體征減輕直至消失。入院時血紅蛋白下降(104.0 g/L),丙氨酸轉氨酶、天門冬氨酸轉氨酶、肌酸激酶、乳酸脫氫酶、總膽紅素、非結合膽紅素、結合膽紅素、肌酐和尿素氮均升高(分別為104.1、101.5、251.5、1 802.5 U/L,96.0、82.5、13.1、168.7μmol/L,13.3 mmol/L);治療第3天,總膽紅素、非結合膽紅素明顯下降至29.1和16.3μmol/L;治療第10天,紅細胞和血紅蛋白低于正常值下限,丙氨酸轉氨酶和肌酐高于正常值上限,總膽紅素、非結合膽紅素、天門冬氨酸轉氨酶、肌酸激酶、乳酸脫氫酶、尿素氮均恢復正常。透析液和尿液中的砷質量濃度在治療后第3天恢復正常。6周隨訪時,所有實驗室指標恢復正常。[結論]PE、HP及CVVH聯(lián)合治療對急性砷化氫中毒有較好的療效。
[Abstract]:[objective] to observe the therapeutic effect of three blood purification methods on patients with acute hydrogen arsenide poisoning. [methods] Twenty patients with acute hydrogen arsenide poisoning from 2002 to 2011 in the first affiliated Hospital of Kunming Medical University were treated with plasmapheresis combined with hemoperfusion and continuous venous hemofiltration (CVVH) after basic treatment. The clinical manifestations and laboratory indexes were observed before and after treatment. [results] Twenty patients with acute hydrogen arsenide poisoning had symptoms of chills, fever, headache, fatigue, waist and back soreness, scleral skin yellow stain, anemia and hemoglobinuria before admission. After 4 days of treatment, the above symptoms and signs were alleviated until they disappeared. On admission, hemoglobin decreased by 104.0 g / L, alanine aminotransferase, aspartate aminotransferase, creatine kinase, lactate dehydrogenase, total bilirubin, unconjugated bilirubin, conjugated bilirubin, Creatinine and urea nitrogen were increased (104.1101.5 / 251.5U / L 802.5 U / L 96.0 / 82.5g / L 13.1168.7 渭 mol / L / L, 13.3 mmol / L / L respectively; on the third day of treatment, total bilirubin and unconjugated bilirubin decreased significantly to 29.1 渭 mol / L and 16.3 渭 mol / L, respectively; on the 10th day of treatment, red blood cell and hemoglobin were below the lower limit of normal value, and the total bilirubin and unconjugated bilirubin decreased significantly to 29.1 and 16.3 渭 mol / L respectively. Total bilirubin, unconjugated bilirubin, aspartate aminotransferase, creatine kinase, lactate dehydrogenase and urea nitrogen all returned to normal. The concentration of arsenic in dialysate and urine returned to normal at the 3rd day after treatment. [conclusion] the combination therapy of PETHP and CVVH has better curative effect on acute hydrogen arsenide poisoning.
【作者單位】： 昆明醫(yī)科大學第一附屬醫(yī)院急診科;云南省祥鵬航空公司;
【分類號】：R595

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