血液灌流对硝氯酚中毒的疗效观察.docVIP

血液灌流对硝氯酚中毒的疗效观察 　　【摘要】 目的：了解血液灌流对硝氯酚中毒的疗效。方法：回顾楚雄州医院急诊科2000-2015年曾行血液灌流的10例硝氯酚中毒资料，统计相关生化指标，评价血液灌流效果。结果：患者入院后CK、CK-MB、LDH、ALT、AST极端值与其正常参考值比较差异均有统计学意义（P0.05）。血液灌流后CK、CKMB、LDH、ALT、AST均无显著下降；第1次灌流后ALT、AST均不降反升。结论：血液灌流对硝氯酚中毒理论有效，但本组病例疗效有限，临床疗效有待更大样本的检验。应重视早期清除毒物，如早期催吐、洗胃、导泻。 　　【关键词】 硝氯酚； 中毒； 血液灌流 　　中图分类号 R595 文献标识码 A 文章编号 1674-6805（2016）10-0009-03 　　【Abstract】 Objective：To understand the effect of the hemoperfusion in the treatment of niclofolan poisoning.Method：10 cases with hemoperfusion were reviewed from 2000 to 2015 in the emergency department of the People’s Hospital of Chuxiong Yi Nationality Autonomous Prefecture，which were against poisoning caused by niclofolan，the related biochemical indexes were counted by statistics，and evaluated the effect.Result：Extreme value of the CK，CKMB，LDH，ALT，AST after admission compared with the normal reference value，there were statistically significant differences（P0.05）.After hemoperfusion，there were no significant decline of CK，CKMB，LDH and ALT，AST，ALT，AST rose significantly after the first hemoperfusion.Conclusion：Hemoperfusion is effective for the poisoning caused by niclofolan in theory，but the curative effect of the above cases are not satisfied，clinical effect will be evaluated from the more cases.Removing poison as early as possible should be pay attention，such as early vomiting，gastric lavage，catharsis. 　　【Key words】 Niclofolan； Poisoning； Hemoperfusion 　　First-author’s address：Chuxiong Yi Nationality Autonomous Prefecture People’s Hospital，Chuxiong 675000，China 　　doi：10.14033/j.cnki.cfmr.2016.10.004 　　硝氯酚又名拜耳9015，化学式C12H6Cl2N2O6，分子量345.06，是脂溶性物质[1]。硝氯酚可抑制体内三羧酸循环中的琥珀酸脱氢酶，从而使体内ATP生成减少，易对含有脂质的神经系统造成损伤，口服超过4 mg/kg可致中毒，重者出现截瘫、失明、死亡。虽然发病率不高，但致残、致死率高[2]。现对楚雄州医院2000-2015年收治的10例血液灌流病例进行回顾分析，现报告如下。 　　1 资料与方法 　　1.1 一般资料 　　口服硝氯酚中毒患者10例。其中男7例，女3例；年龄最大60岁，最小13岁，平均48.7岁；误服3例，自杀7例；服毒量0.2～5.0 g；平均住院9.2 d。服毒病史、毒物样品及包装均由患者及家属提供，无毒物鉴定。主要症状是大量出汗及肌肉酸痛，部分有皮肤潮红、发热、呕吐、腹痛、头昏、头痛、乏力、心慌、胸闷、烦躁、视力模糊、强直痉挛、死亡。 　　1.2 特殊病例 　　1.2.1 死亡2例 1