血液净化联激素抢救毒蕈中毒性急性肾衰竭的临床研究.docVIP

血液净化联合激素抢救毒蕈中毒性急性肾衰竭的临床研究 摘要: 目的:探讨采用血液灌流串联血液透析联合小剂量激素抢救毒蕈致中毒性急性肾衰 竭的疗效。方法:血液灌流串联血液透析每次3h,1次/d,小剂量糖皮质激素3~5d。监测血 清ALT?AST?BUN?Cr及尿量恢复情况。结果:12例患者共行60 次血液灌流串联血液 透析治疗,10例患者在治疗后第5天各项指标基本恢复正常。尿量增加于治疗后平均3.6d出 现,进入多尿期平均5.3d。结论:血液灌流串联血液透析,联合小剂量糖激素治疗毒蕈致中 毒性急性肾衰竭的疗效肯定。 关键词:血液灌流;血液透析;毒蕈;急性肾衰竭 中图分类号: R692.5;R595.7 文献标识码: A 文章编号: 1008-2409(2009)05-0820-03 A clinical study to blood purrification and glucocorticoid in the rescue acute renal failure because of toadstool/LI Kang-hui,YIN You-sheng,WEI Jia-zhi,et al.∥The Department of Urology Me dicine,The Attificial Hospital of Guilin Medical College, Guilin 541001, China Abstract:Objective: To explore the curative effect of hemoperfusion cascade he modialysis to rescue acute renal failure because oftoadstool.Methods:All patientsweretreated with hemoperfusion cascade hemodialysis one time a day, 3hours/time.They were treated with minidose glucocorticoid 3~5 days. Monito inde xs:blood serum——ALT?AST?BUN?Cr and urine volume reablement. Results: 12patientsweretreated with hemoperfusion cascade hemodialysis60 times inall. 10 patients indexs rebound normal after 5 days. Their urine volume incre ased in 3.6 days and came to diuresis stage in5.3 daysmedially. Conclusion :It was affirmative that hemoperfusion cascade hemodialysis and minidose glucoc orticoid to rescue acute renal failure because oftoadstool. Key words:hemoperfusion; hemodialysis; toadstool; acute renal fai lure 凡由药物?化学物质或生物毒素引起的肾脏结构和(或)功能损害并具有相应临床过程者称 为中毒性肾病,在中毒性肾病中表现为急性肾衰竭者则称为中毒性急性肾衰竭[1] 。我科200 7年9月收治12例食用毒蕈中毒的患者,其中表现为中毒性急性肾衰竭伴心脏?肝脏等多个脏 器损伤的病例共10例,仅表现为心脏损害者1例,表现为肝脏损害者1例。12例患者均采用 树脂罐血液灌流串联血液透析(HP+HD),联合小剂量糖皮质激素治疗,取得良好疗 效。 1 资料与方法 1.1 一般资料 12例患者为桂北地区兴安?全州?灌阳县居民,其中男4例,女8例;年龄25~66岁之间 ,平均38.75岁,均无基础疾病。发病前有明确误食毒蕈史 250~500g之间,其中有1例 仅误食毒蕈汤。全部病例均于食用一种当地称为“白伞蕈”的毒蕈后出现恶心?腹痛?腹泻 ,潜伏期最短1h,最长72h,平均16.75h;8例出现少尿或无尿,最长3d出现,最短 6h出现。食入毒蕈后至来我院就诊时间最长10d,最短2d,平均4.9d。 1.2 诊断标准[2] ①毒蕈食用病史。②毒草中毒的临床表现:包括消化道症状及尿量改变。③肾损害?肝损害 及实验室检查:包括肾功