急性药物或毒物中毒中应用血液净化治疗的时机和方法分析
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摘要
目的探讨急性药物或毒物中毒应用血液净化治疗的时机和方法。方法选择本院收治急性毒物或药物中毒患者60例,所有患者均于2017年1月至2017年12月在本院接受治疗,依据患者情况采取血液透析、血液灌流、床旁连续肾脏替代治疗、血液透析联合血液灌流,统计患者机械通气使用率、Glasgow评分、治愈率、死亡率、住院天数、不良反应。结果引起中毒药物或毒物主要为有机磷农药、混合农药、三环类抗抑郁药。患者平均接受(2.8±0.4)次血液净化治疗,其中40例(66.7%)患者接受血液灌流治疗,6例(10.0%)接受血液透析治疗,6例(10.0%)接受血液灌流+连续性静+静脉血液滤过治疗,8例(13.3%)接受血液灌流+血液透析治疗。46例(76.7%)患者痊愈出院,6例(10.0%)患者自动出院,8例(13.3%)患者死亡。首诊时患者Glasgow评分(5.2±2.1)分,显著低于血液净化治疗3次后的(8.2±1.0)分(P<0.05)。结论在常规治疗基础上依据患者情况尽早、综合应用血液净化治疗,能够使显著提升急性重度中毒患者救治效果,促进患者更快康复,具有较高推广价值。
Objective To explore the timing and methods of blood purification treatment for acute drugs or toxic substances. Methods Sixty patients with acute poison or drug poisoning were enrolled in our hospital. All patients were treated in our hospital from January 2017 to December2017. Hemodialysis, hemoperfusion, bedside continuous renal replacement therapy were adopted according to the patient's condition. Hemodialysis combined with blood perfusion, statistical use of mechanical ventilation, Glasgow score, cure rate, mortality, length of hospital stay, adverse reactions. Results The poisoning drugs or poisons were mainly organophosphorus pesticides, mixed pesticides and tricyclic antidepressants. The patients received an average of(2.8±0.4) blood purification treatments, of which 40(66.7%) received hemoperfusion, 6(10.0%) received hemodialysis,and 6(10.0%) received hemoperfusion + continuous static + venous hemofiltration treatment, 8 cases(13.3%) received blood perfusion + hemodialysis treatment. Forty-six patients(76.7%) were discharged from hospital, 6 patients(10.0%) were discharged automatically, and 8 patients(13.3%)died. At the first visit, the patient' s Glasgow score(5.2±2.1) was significantly lower than(8.2±1.0) points after 3 times of blood purification treatment(P<0.05). Conclusion On the basis of routine treatment, blood purification treatment can be applied as soon as possible according to the patient's condition, which can significantly improve the treatment effect of acute severe poisoning patients and promote faster recovery of patients,which has higher promotion value.
Objective To explore the timing and methods of blood purification treatment for acute drugs or toxic substances. Methods Sixty patients with acute poison or drug poisoning were enrolled in our hospital. All patients were treated in our hospital from January 2017 to December2017. Hemodialysis, hemoperfusion, bedside continuous renal replacement therapy were adopted according to the patient's condition. Hemodialysis combined with blood perfusion, statistical use of mechanical ventilation, Glasgow score, cure rate, mortality, length of hospital stay, adverse reactions. Results The poisoning drugs or poisons were mainly organophosphorus pesticides, mixed pesticides and tricyclic antidepressants. The patients received an average of(2.8±0.4) blood purification treatments, of which 40(66.7%) received hemoperfusion, 6(10.0%) received hemodialysis,and 6(10.0%) received hemoperfusion + continuous static + venous hemofiltration treatment, 8 cases(13.3%) received blood perfusion + hemodialysis treatment. Forty-six patients(76.7%) were discharged from hospital, 6 patients(10.0%) were discharged automatically, and 8 patients(13.3%)died. At the first visit, the patient' s Glasgow score(5.2±2.1) was significantly lower than(8.2±1.0) points after 3 times of blood purification treatment(P<0.05). Conclusion On the basis of routine treatment, blood purification treatment can be applied as soon as possible according to the patient's condition, which can significantly improve the treatment effect of acute severe poisoning patients and promote faster recovery of patients,which has higher promotion value.
引文
[1]王旭,董斌,李弢.序贯性血液净化治疗蜂中毒并多器官功能障碍综合征疗效分析[J].中华实用儿科临床杂志,2015,30(6):442-444.
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[7]李瑛,秦小燕,申晨.专业小组质量控制模式在血液净化治疗急性重症中毒病人中的应用[J].全科护理,2015,12(31):3173-3175.
[8]胡蓬勃,邱建清,许玲.Depmas双重血液净化治疗急性百草枯中毒的疗效观察[J].中华临床医师杂志,2014,12(16):3048-3050.
[9]顾敏,赵成广,吴玉斌.血液净化治疗大剂量甲氨蝶呤中毒致急性肾功能衰竭的疗效[J].实用药物与临床,2013,16(5):392-394.
[10]房开宇,尹健,赵睿.血液净化仪治疗在急性药物或毒物中毒中的应用时机及方法[J].中国医疗器械信息,2018,24(5):131-132.
[11]陈春花,关春辉,何江.祛百解毒汤联合强化血液净化成功救治百草枯中毒患者1例报道[J].现代医药卫生,2017,33(16):2574-2576.
[12]马为民,张欣,潘秀刚.连二亚硫酸钠法尿百草枯半定量检测在急性百草枯中毒患者血液净化治疗中的应用[J].中国基层医药,2015,11(8):1235-1237.
[13]陈涛,胡华元,周凤娇.序贯性血液净化在治疗中毒合并多器官功能障碍综合征的临床疗效观察[J].齐齐哈尔医学院学报,2018,39(2):148-149.
[14]李国强,燕朋波,孙秀明.全国第六届中毒救治与血液净化培训班暨武警后勤学院附属医院"第九届中毒急救论坛"圆满落幕[J].中华灾害救援医学,2017,5(11):662.
[15]李小鹏,钟渊斌,张伦理.血液净化联合内科常规治疗与单纯药物治疗64例重症毒蕈中毒效果比较[J].中国肝脏病杂志,2016,12(4):50-54.
[16]陈庞何.血液净化与药物联合治疗对重度急性有机磷中毒患者的临床疗效分析[J].齐齐哈尔医学院学报,2015,12(28):4249-4250.
[2]毕红英,付建宇,唐艳.集成血液净化治疗百草枯中毒肝衰竭患者的临床体会[J].中国中西医结合急救杂志,2017,24(6):660-662.
[3]陈德政,张凌,李明鹏.早期强化血液净化治疗重症蜂毒中毒合并急性肾损伤120例疗效观察[J].中华肾脏病杂志,2016,32(11):833-838.
[4]刘力新,魏远辉,李炬带.早期紧急气道开放及机械通气联合血液净化救治急性中毒合并呼吸衰竭疗效观察[J].广东医学,2017,32(4):494-495.
[5]焦清海,王健,张雪梅.早期持续血液净化对有机磷中毒患者血清肿瘤坏死因子α、白细胞介素8及白细胞介素18水平影响[J].临床误诊误治,2016,29(8):94-97.
[6]纪永松,杜凯阳,郭伟萍.急性百草枯中毒的早期血液净化联合激素和环磷酰胺冲击治疗[J].中华劳动卫生职业病杂志,2017,31(5):388-389.
[7]李瑛,秦小燕,申晨.专业小组质量控制模式在血液净化治疗急性重症中毒病人中的应用[J].全科护理,2015,12(31):3173-3175.
[8]胡蓬勃,邱建清,许玲.Depmas双重血液净化治疗急性百草枯中毒的疗效观察[J].中华临床医师杂志,2014,12(16):3048-3050.
[9]顾敏,赵成广,吴玉斌.血液净化治疗大剂量甲氨蝶呤中毒致急性肾功能衰竭的疗效[J].实用药物与临床,2013,16(5):392-394.
[10]房开宇,尹健,赵睿.血液净化仪治疗在急性药物或毒物中毒中的应用时机及方法[J].中国医疗器械信息,2018,24(5):131-132.
[11]陈春花,关春辉,何江.祛百解毒汤联合强化血液净化成功救治百草枯中毒患者1例报道[J].现代医药卫生,2017,33(16):2574-2576.
[12]马为民,张欣,潘秀刚.连二亚硫酸钠法尿百草枯半定量检测在急性百草枯中毒患者血液净化治疗中的应用[J].中国基层医药,2015,11(8):1235-1237.
[13]陈涛,胡华元,周凤娇.序贯性血液净化在治疗中毒合并多器官功能障碍综合征的临床疗效观察[J].齐齐哈尔医学院学报,2018,39(2):148-149.
[14]李国强,燕朋波,孙秀明.全国第六届中毒救治与血液净化培训班暨武警后勤学院附属医院"第九届中毒急救论坛"圆满落幕[J].中华灾害救援医学,2017,5(11):662.
[15]李小鹏,钟渊斌,张伦理.血液净化联合内科常规治疗与单纯药物治疗64例重症毒蕈中毒效果比较[J].中国肝脏病杂志,2016,12(4):50-54.
[16]陈庞何.血液净化与药物联合治疗对重度急性有机磷中毒患者的临床疗效分析[J].齐齐哈尔医学院学报,2015,12(28):4249-4250.