野生菌中毒多器官功能衰竭血浆置换效果分析
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摘要
目的探讨血浆置换对野生菌中毒合并多器官功能衰竭患者的辅助治疗效果。方法回顾2014年5月1日—2017年8月31日期间实施血浆置换的野生菌中毒合并多器官功能衰竭患者病例,收集患者血浆置换次数、数量,并对患者治疗前后心脏、肝脏、肾脏功能、凝血功能相关指标及临床症状进行对比分析。结果 5例野生菌中毒合并多器官功能衰竭患者,经及时有效的血浆置换治疗,谷丙转氨酶(ALT)、谷草转氨酶(AST)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、α-羟丁酸脱氢酶(α-HBDH)明显下降,心脏、肝脏功能得到有效恢复。其中2例患者肾功能损伤后恢复相对较心、肝缓慢,1例患者病情较为复杂,血尿素氮(BUN)、血肌酐(CREA)血浆置换期间有升高趋势,但经过后续治疗,治愈出院。结论野生菌中毒合并多器官功能衰竭在早期及时有效的进行血浆置换可有效清除患者体内有毒物质,有利于各个器官功能得到及时恢复,改善预后,挽救患者生命。
Objective To explore the adjuvant therapeutic effect of plasma exchange on the patients with multiple organ failure.Methods Review on May 1,2014—August 31,2017,during the implementation of the plasma exchange merger of wild fungus poisoning cases of patients with multiple organ failure,collect patients plasma exchange number,quantity,and before and after treatment in patients with heart,liver,kidney function,blood coagulation function related indicators and clinical symptoms were analyzed.Results After the prompt effective plasma exchange treatment,5 cases of wild fungus poisoning patients with combined multiple organ failure,ALT,AST,CK,CK-MB and α-HBDH decreased obviously,heart,liver function recovered effectively.Including 2 cases of patients with renal function injury recovery is relatively slow the heart,liver,1 case of patient condition is relatively complex,BUN,CREA during plasma exchange,had a tendency to rise,but after follow-up treatment,cure the hospital.Conclusion Wild fungus poisoning combined multiple organ failure in the early days of the timely and effective for patients with plasma exchange can effectively remove poisonous substances in the body,is advantageous to the various organs function recovered in time,improve the prognosis,save patients' lives.
Objective To explore the adjuvant therapeutic effect of plasma exchange on the patients with multiple organ failure.Methods Review on May 1,2014—August 31,2017,during the implementation of the plasma exchange merger of wild fungus poisoning cases of patients with multiple organ failure,collect patients plasma exchange number,quantity,and before and after treatment in patients with heart,liver,kidney function,blood coagulation function related indicators and clinical symptoms were analyzed.Results After the prompt effective plasma exchange treatment,5 cases of wild fungus poisoning patients with combined multiple organ failure,ALT,AST,CK,CK-MB and α-HBDH decreased obviously,heart,liver function recovered effectively.Including 2 cases of patients with renal function injury recovery is relatively slow the heart,liver,1 case of patient condition is relatively complex,BUN,CREA during plasma exchange,had a tendency to rise,but after follow-up treatment,cure the hospital.Conclusion Wild fungus poisoning combined multiple organ failure in the early days of the timely and effective for patients with plasma exchange can effectively remove poisonous substances in the body,is advantageous to the various organs function recovered in time,improve the prognosis,save patients' lives.
引文
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[8]徐丽娟,陆颖,蒋奔,等.血浆置换治疗移植后血栓性微血管病成功1例.临床输血与检验,2015,17(2):178-179.
[9]徐丽娟,赵欣欣,张美婷,等,血浆置换辅助治疗嗜血细胞综合征1例.中国输血杂志,2016,29(11):1277-1278.
[10]陈丽霞,林恢,朱灯,等.血浆置换治疗肝衰竭的疗效观察.中国卫生标准,2016,15(7):61-64.
[11]秦军建,陈睿达,闫可可,等.血浆置换联合血液灌流治疗急性肾功能衰竭的临床效果观察.河南医学研究,2016,25(3):437-438.
[12]Feibi Z,Tomofumi T,Naofumi Y.A case of fatal heart and liver failure accompanied by thyroid storm treated with prompt plasma exchange.Journal of Cardiology Cases,2017,15(3):100-103.
[13]Lee JY,Kim SB,Chang JW.Comparison of the Molecular Adsorbent Recirculating System and Plasmapheresis for Patients With Graft Dysfunction After Liver Transplantation.Transplantation Proceedings,2010,42(7):2625-2630.
[2]卯晓岚.中国毒菌物种多样性及其毒素.菌学报道,2006,25(3):345-363.
[3]吴淡森,石松菁.多器官功能衰竭救治进展.中华急诊医学杂志,2014,23(8):844-846.
[4]Francois P,Stéphane L.Multiple Organ Dysfunction Syndrome.Springer London,2014,66(5):477-487.
[5]方克美,扬大明,常俊,等.急性中毒治疗学.南京:江苏科学技术出版社,2002:311.
[6]杨江英,吴邦富,江朝强,等.传统血液净化、血浆置换及MARS人工肝救治肝损害型白毒伞类毒蘑菇中毒.中国血液净化,2003,2(7):395-398.
[7]段前碧,李忠俊.治疗性血浆置换在临床各类疾病治疗中的研究进展.重庆医学,2007,36(24):2514-2515.
[8]徐丽娟,陆颖,蒋奔,等.血浆置换治疗移植后血栓性微血管病成功1例.临床输血与检验,2015,17(2):178-179.
[9]徐丽娟,赵欣欣,张美婷,等,血浆置换辅助治疗嗜血细胞综合征1例.中国输血杂志,2016,29(11):1277-1278.
[10]陈丽霞,林恢,朱灯,等.血浆置换治疗肝衰竭的疗效观察.中国卫生标准,2016,15(7):61-64.
[11]秦军建,陈睿达,闫可可,等.血浆置换联合血液灌流治疗急性肾功能衰竭的临床效果观察.河南医学研究,2016,25(3):437-438.
[12]Feibi Z,Tomofumi T,Naofumi Y.A case of fatal heart and liver failure accompanied by thyroid storm treated with prompt plasma exchange.Journal of Cardiology Cases,2017,15(3):100-103.
[13]Lee JY,Kim SB,Chang JW.Comparison of the Molecular Adsorbent Recirculating System and Plasmapheresis for Patients With Graft Dysfunction After Liver Transplantation.Transplantation Proceedings,2010,42(7):2625-2630.