中国肝脏病杂志（电子版）
中國肝髒病雜誌（電子版）
중국간장병잡지（전자판）
CHINESE JOURNAL OF LIVER DISEASES(ELECTRONIC VERSION)
2013年
4期
50-54
,共5页
血液净化%内科治疗%毒蕈%中毒%多器官功能衰竭
血液淨化%內科治療%毒蕈%中毒%多器官功能衰竭
혈액정화%내과치료%독심%중독%다기관공능쇠갈
Blood puriifcation%Conventional medical treatment%Mushroom%Poisoning%MODS
目的：评价群发性重症毒蕈中毒患者血液净化联合内科常规治疗与单纯药物治疗的疗效比较。方法比较采用血液净化（包括分子吸附再循环系统、血浆置换、血液透析、血液滤过、血液灌流等技术）联合内科常规治疗与单纯药物治疗对64例重症毒蕈中毒患者的临床表现、实验室检查、治疗效果及预后进行回顾性分析。结果毒蕈中毒常有肝、肾、呼吸、循环、神经系统、消化道、凝血等多脏器、多系统损害，急性生理学及慢性健康状况评分系统显示（APACHE Ⅱ评分），随分值增加，病死率递增。40例联合治疗组在内科常规治疗的基础上加用血液净化，治愈率为75%（30/40）；24例药物治疗组给予单纯药物治疗，治愈率仅为25%（6/24），联合治疗组治愈率明显高于药物治疗组（P =0.000）。两组患者治疗后血液ALT、AST、TBil、DBil、GLB、Bun、HBDH、PT较治疗前有明显改善（P均＜0.05），而治疗后ALB、TD、Cr、CK、CKMB等指标虽有下降，但差异无统计学意义（P均＞0.05）。结论重症毒蕈中毒患者随脏器损害增多，病死率递增，血液净化治疗对抢救重症毒蕈中毒有肯定的疗效，能较好的清除毒蕈毒素，减少毒素吸收，减轻肝、肾功能损害，改善凝血功能，帮助患者度过危险期，根据病情需要及早行血液净化治疗能明显改善预后，提高生存率，降低病死率。
目的：評價群髮性重癥毒蕈中毒患者血液淨化聯閤內科常規治療與單純藥物治療的療效比較。方法比較採用血液淨化（包括分子吸附再循環繫統、血漿置換、血液透析、血液濾過、血液灌流等技術）聯閤內科常規治療與單純藥物治療對64例重癥毒蕈中毒患者的臨床錶現、實驗室檢查、治療效果及預後進行迴顧性分析。結果毒蕈中毒常有肝、腎、呼吸、循環、神經繫統、消化道、凝血等多髒器、多繫統損害，急性生理學及慢性健康狀況評分繫統顯示（APACHE Ⅱ評分），隨分值增加，病死率遞增。40例聯閤治療組在內科常規治療的基礎上加用血液淨化，治愈率為75%（30/40）；24例藥物治療組給予單純藥物治療，治愈率僅為25%（6/24），聯閤治療組治愈率明顯高于藥物治療組（P =0.000）。兩組患者治療後血液ALT、AST、TBil、DBil、GLB、Bun、HBDH、PT較治療前有明顯改善（P均＜0.05），而治療後ALB、TD、Cr、CK、CKMB等指標雖有下降，但差異無統計學意義（P均＞0.05）。結論重癥毒蕈中毒患者隨髒器損害增多，病死率遞增，血液淨化治療對搶救重癥毒蕈中毒有肯定的療效，能較好的清除毒蕈毒素，減少毒素吸收，減輕肝、腎功能損害，改善凝血功能，幫助患者度過危險期，根據病情需要及早行血液淨化治療能明顯改善預後，提高生存率，降低病死率。
목적：평개군발성중증독심중독환자혈액정화연합내과상규치료여단순약물치료적료효비교。방법비교채용혈액정화（포괄분자흡부재순배계통、혈장치환、혈액투석、혈액려과、혈액관류등기술）연합내과상규치료여단순약물치료대64례중증독심중독환자적림상표현、실험실검사、치료효과급예후진행회고성분석。결과독심중독상유간、신、호흡、순배、신경계통、소화도、응혈등다장기、다계통손해，급성생이학급만성건강상황평분계통현시（APACHE Ⅱ평분），수분치증가，병사솔체증。40례연합치료조재내과상규치료적기출상가용혈액정화，치유솔위75%（30/40）；24례약물치료조급여단순약물치료，치유솔부위25%（6/24），연합치료조치유솔명현고우약물치료조（P =0.000）。량조환자치료후혈액ALT、AST、TBil、DBil、GLB、Bun、HBDH、PT교치료전유명현개선（P균＜0.05），이치료후ALB、TD、Cr、CK、CKMB등지표수유하강，단차이무통계학의의（P균＞0.05）。결론중증독심중독환자수장기손해증다，병사솔체증，혈액정화치료대창구중증독심중독유긍정적료효，능교호적청제독심독소，감소독소흡수，감경간、신공능손해，개선응혈공능，방조환자도과위험기，근거병정수요급조행혈액정화치료능명현개선예후，제고생존솔，강저병사솔。
Objective To evaluate the clinical effect difference between blood purification combined with medical conventional treatment and simple drug treatment for group attack of severe mushroom poisoning patients. Methods Compared with blood puriifcation treatment (including molecular adsorption recirculation system, plasma exchange, hemodialysis, hemofiltration, hemoperfusion and other technology) joint with conventional medical treatment and simple drug medical treatment on 64 severe mushroom poisoning patients. Clinical manifestations, laboratory examination, treatment effect and prognosis were retrospecively analyze. Results Severe mushroom poisoning patients often have liver, kidney, respiration, circulation, nerve system, enteron, clotting etc multiple organ dysfunction. Acute physiology and chronic health evaluation (APACHEⅡ score) showed, with the score increases, the mortality increasing. Total of 40 patients on the basis of conventional treatment combined with blood puriifcation, cured 30 cases, the cure rate is 75%, while 24 patients with simple drug treatment, cured 6 cases, the cure rate is only 25%. Combined treatment group was obviously higher than that of pure drug therapy group (P<0.01). After blood puriifcation, ALT, AST, TBil, DBil, GLB, Bun, HBDH, PT levels were signiifcantly reduced than before blood puriifcation (all P<0.05), while ALB, TD, Cr, CK, CKMB have fallen, but no signiifcantl difference (all P>0.05). Conclusions Severe mushroom poisoning patients with the more viscera damage, the more mortality increased. Blood puriifcation treatment for these patients have deifnite therapy effect to the beneift of remove toxins, reduce toxins absorption, relieve liver and kidney damage, improve coagulation function to make for patients through crisis. According to the state of illness, early blood puriifcation treatment can obvious improve prognosis, improve the survival rate, reduce mortality.
