严重急性药物、毒物中毒时血液灌流和血液透析疗法的临床应用及评价

急性药物或毒物逾量中毒患者,经洗胃、催吐、导泻、利尿,应用一般或专一的解毒剂,致力于维持呼吸和循环,纠正水电解质和酸碱紊乱,常可使大多数患者转危为安,但对严重中毒患者上述治疗常难奏效,中毒本身和较长时间昏迷引起的并发症,常可致命。血液透析或血液灌流疗法,借透析或吸附     

DETERMINATION OF MIDDLE MOLECULES IN UREMIC PATIENTS

For the past few years, we have been engaged in isolating and separating middle molecules (MMs) from biologic fluids of healthy persons and uremic patients. Plasma or serum, ultrafiltrate, and peri- toneal outflow dialysate from uremic patients, as well as plasma from healthy subjects, were fractionat- ed by gel chromatography. Plasma or serum was pretreated with a 40 x l cm Sephadex G 50 column or by CXA ultrafilter. Fractionation of MMs was performed on a 100 x I cm Sephadex G 15 column, eluted with NH.HCO:} buffer. UV absorbance was measured at 206 nm, 225 nm, or both. All samples could be separated into about 10 peaks according to elution volume. Peak 2 and peak 3, corresponding to the elution volumes for vitamin B12 and oxytocin, were significantly higher in uremic than healthy sera. These two peaks were regarded as the main fractions containing uremic MMs. MMs measurement was used to: a) evaluate the efficiency of various dialyzers and hemoperfusion, b) evaluate the efficacy of continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) in the removal of MMs, c) calculate the total quan tity of MMs removed by CAPD, intermittent peri- toneal dialysis and ultrafiltration, and d) assess the efficacy of reused dialyzers. Subfractionation of MMs by thin layer finger prints technic was carried out. Identification of the separated substances is in progress.     

TRENCH FEVER A RESUME OF LITERATURE AND A NOTE ON SOME OBSCUP\E PHASES OF THE DISEASE

Although trench tever is now known to be almost worldwide in distribution, it usually exists unrecognized in louse-infested cornm.uni- ties in peace time, and the disease may flare up in epiclemic form in wartime. Inasmuch as phy- sicians are generally unfamiliar with trench fever, the literature on the history, geographic distribution, symptomatology, pathology, etio- logy, immunity, diagnosis, epidemiology, pre- vention and treatment of the diseas.e iS briefly reviewed. Certain obscure phases of trench fe- ver are noted and lines for further studies of the disease suggested. The question is enterta.in- ed whether R rocha-lima, a rickettsia of hitherto undefined status., may represent a variant of R prowazeki acquired by lice feeding on typhus oonvalescent,s living under nat.urall conditions and an intermedia.te stage in the transformation of R prowazeki in the direction of R quintana.     

血液透析和血液灌流治疗急性药物、毒物中毒——29例临床分析

本文介绍应用血液透析或血液灌流分别治疗12例和17例重症药物逾量或毒物中毒的经验。临床结果表明血液透析或血液灌流均能有效地直接从血液中清除某些药物和毒物。前者对水溶性物质、重金属离子等有效、尤适用于伴肾损害、电解质和酸碱紊乱的病人。后者对去除脂溶性或与蛋白质结合的物质效果较好。本文就血液透析和血液灌流治疗中毒的适应证、血液灌流和药物联合治疗重度有机磷农药中毒等进行了讨论。     

CONTINUOUS AMBULATORY PERITONEAL DIALYSISCLINICAL REPORT OF 62 CASES

Sixty-two patients with cnd stage renal disease wcrc selected for continuous ambulatory peritoneal dialysis (CAPD) from Sept 1980 to March 1983, CAPD was performed with plastic bags containing 2-liter dialysate solution. Most patients commenced with 4 bag exchanges per day, with good results. The total treatment time was 558 patient- months in 31 months. 42 patients were treated for Jnore than 6 months and 24 for more than 12 months. The longest survival was 24 months. 22 patients died. 30 had CAPD at home for 2-16 months. The mean pcritoneal clearance of urea nitrogen and creatinine was 7.5+2.8 ml/min and 13.4+5.3 mL/min, respectively. Plasma middle molecules were significantly lower after CAPD. Clinical features of heart failure and pericarditis disappeared within 1-4 weeks. The mean protein and FAA losses in the dialysate were respectively 14.4+8.0 and 2.1+0.5 g per day. The most outstanding complication was perito nitis. Gram positive organisms predominated. There was one episode of peritonitis per 8.2 patient. months. Bacterial pcritonitis was early treated with prolonged peritoneal lavage and drainage without the addition of antibiotics. The possible development of ventricular arrhyth. mias due to hypopotassemia resulting from long-term use of potassium-free dialysate and from glucose iii take through the peritoneal route is discussed.     

失血性休克用晶、胶体液复苏的比较研究(摘要)

18只犬放血,血压维持在40mmHg一小时,回输血后分成二组。9只犬给予失血量相等的中分子右旋糖酐(36ml/kg),余9只给3倍于其失血量的林格乳酸钠液(103ml/kg)。休克前、后及复苏中定时监测心、肺、肾功能及代谢参数计4小时。实验表明:休克时心脏指数、左室每搏做功指数及中心静脉压     

失血性休克用晶、胶体液复苏的比较研究

本文报道林格氏乳酸钠液与右旋糖酐氯化钠液在出血性休克犬(18条)复苏时心、肺、肾功能及代谢变化的比较。结果表明两者均能恢复血液动力学的稳定,组织氧供恢复良好,心肌收缩性两组无差别。晶体组用液量较大,但无肺水肿表现,两组肺功能均满意恢复。右旋糖酐扩容效果较持久,但肾滤过率、尿量及渗透清除率均较晶体组低(P<0.05),肾功能恢复较差。作者认为在出血性休克的复苏治疗中应以晶体液为首选。     

HEMOPERFUSION WITH GELATIN-ENCAPSULATED CHARCOAL

In this paper, micro-in-macro gelatin-encap- sulated activated charocal (MMAC), a double gelatin-coated activated charcoal, is recommend- ed a.s an effective adsorbent for clinical hemo- perfusion (HP). In vitro studies show that the clearance and adsorption values for a variety of substances are as good as those with uncoated or collodion- coated activated cocon ut charcoal. Blood compatibility is excellent and particulate release minimal. Clinical conditions for which MMAC HP has been tried include acute drug overrdose, po.isoning, chronic uremia and schizo- phrenia. Experience suggesits that MMAC HP is effective and safe in the treatment of intoxica- tifflis. It is also a useful adjunct to hemodialysis in the treatment of uremia. As for schizophrenia, further study is needed. The shortcomings of MMAC are also discussed.     

尿毒症的中分子量物质测定

本文介绍应用凝胶层析法检测尿毒症中分子物质的方法,与正常人比较,尿毒症病人血清中有异常的中分子量物质积聚,实验结果表明了解这些物质被清除的情况,有助于对血液透析、血液灌流、腹膜透析的效能作出评价,简化实验方法可推广用于临床,观察疗效。中分子物质的进一步分离和鉴定仍在继续进行。     

血液灌流抢救急性药物过量的疗效观察

本文报道用血液灌流抢救10例急性严重药物过量的精神病患者,其中8例完全恢复,2例失败。在抢救成功的病例中,血液灌流对氯丙嗪,泰尔登,奋乃静,氟哌啶醇,阿米替林,安眠酮,安定和水化氯醛等药物有良好的吸除效果,从而较快地促使病人苏醒。