CAJ | 학술논문

目的探讨血液灌流对治疗急性2,4-二硝基苯酚中毒的作用.方法采用自身前后对照的方法,对2009年9月14日我院收治的14例急性2,4-二.硝基苯酚中毒患者根据入院时的临床症状分为重度中毒组和轻度中毒组,两组患者均于入院后2h内予血液灌流治疗,观察治疗前后临床症状缓解情况、相关实验室指标变化,用液质联用法检测每次灌流治疗前后血2,4-二硝基苯酚水平变化.所有患者同时予对症和支持治疗.结果重度中毒组患者灌流治疗1次后,临床症状明显缓解,治疗前后2,4-二硝基苯酚水平分别为28.21(15.56～ 45.23)和16.11 (10.10 ～27.52) mg/L,差异有统计学意义(P＜0.05),但3h后症状反跳,连续治疗3次后主要临床症状缓解无反跳,连续治疗6次,主要临床症状基本消失.轻度中毒组患者治疗2次后临床症状基本消失,无反跳.两组患者均救治成功,中性粒细胞及血小板计数下降,肝酶上升,出院后1及3个月进行随访均无明显后遗症.结论两组患者临床症状的严重程度与毒物浓度呈密切相关,血液灌流能有效清除中毒患者体内的2,4-二硝基苯酚,迅速下降血液毒物浓度,缓解临床症状,提高存活率.
목적 탐토혈액관류대치료급성2,4-이초기분분중독적작용.방법 채용자신전후대조적방법,대2009년9월14일아원수치적14례급성2,4-이.초기분분중독환자근거입원시적림상증상분위중도중독조화경도중독조,량조환자균우입원후2h내여혈액관류치료,관찰치료전후림상증상완해정황、상관실험실지표변화,용액질련용법검측매차관류치료전후혈2,4-이초기분분수평변화.소유환자동시여대증화지지치료.결과 중도중독조환자관류치료1차후,림상증상명현완해,치료전후2,4-이초기분분수평분별위28.21(15.56～ 45.23)화16.11 (10.10 ～27.52) mg/L,차이유통계학의의(P＜0.05),단3h후증상반도,련속치료3차후주요림상증상완해무반도,련속치료6차,주요림상증상기본소실.경도중독조환자치료2차후림상증상기본소실,무반도.량조환자균구치성공,중성립세포급혈소판계수하강,간매상승,출원후1급3개월진행수방균무명현후유증.결론 량조환자림상증상적엄중정도여독물농도정밀절상관,혈액관류능유효청제중독환자체내적2,4-이초기분분,신속하강혈액독물농도,완해림상증상,제고존활솔.
Objective To explore the management strategies of acute toxication of 2,4-dinitrophenol by hemoperfusion.Methods A total of 14 patients with acute toxication of 2,4-dinitrophenol were admitted on September 14,2009.And they were divided into severe and mild groups according to the severify of clinical manifestation.All patients in both groups received 2-hour blood perfusion within 2 hour postadmission.Their clinical manifestations,laboratory parameters and 2,4-dinitrophenol levels were carefully observed before and after each perfusion.And oxygenation,intravenous use of furosemide,corticosteroids and symptomatic therapies were simultaneously given to improve general conditions.Results In serious group,the levels of before and after the first perfusion were 28.21 (15.56-45.23) and 16.11 (10.10-27.52) mg/L (P ＜0.05),respectively.In both groups,all levels of 2,4-dinitrophenol were significantly reduced before and after each perfusion (all P ＜ 0.05).The patients in severe group would get relieved after 3 vs 2 perfusions in mild group.In severe group,there was a remarked decrease in neutrophil and platelet count after perfusion than those in mild group.The liver enzymes and blood lipids in both groups after therapy significantly elevated than those before therapy (all P ＜ 0.05).Conclusion Crucial for managing acute toxication of 2,4-dinitrophenol,early hemoperfusion reduces mortality.