毒蕈中毒致急性肾功能衰竭1例报告

患者女，50岁。26d前单位郊游服用野生蕈类，烹调方法为炖、炒，事后32人都出现了恶心、呕吐、腹泻等症状，按食物中毒给予止吐、抗炎、对症治疗好转。该患仅出现水样便2d，但未治疗，于26d后出现发热、恶心、呕吐、腹痛伴腹泻，体温最高达38．8℃，按感冒治疗，     

毒蕈中毒致急性肾功能衰竭20例临床分析

我院自 1996年 1月至今共收治毒蕈中毒 34例 ,其中引起急性肾功能衰竭 2 0例 ,现将其临床特点及诊治报告如下。1　临床资料1.1　一般情况 :本组 2 0例 ,男 8例 ,女 12例 ;年龄 15～ 5 5岁。既往无肾脏病史。均有食野蕈史 ,同餐者有类似发病。1.2　临床表现 :服野蕈后数小时所有病人均出现不同程度的恶心、呕吐 ,18例出现腹痛、腹泻等胃肠道症状 ,10例伴有头昏、头痛 ,3例昏迷。 2 0例均于当日或次日出现少尿甚至无尿 ,少尿期持续 2～ 9天 ,多尿期持续 2～ 10天不等 ,尿量最多为6 80 0 ml/ 2 4小时。1.3　实验室检查 :全部病例均有不同程度的…     

急性重度毒蕈中毒10例救治体会

毒蕈又称毒蘑菇、毒菌,食用后可导致中毒,医学论著上常有学者报道,易群体发病,严重者可出现多脏器损害,因毒蕈种类较多,所含毒素不同,中毒后临床表现和脏器损害程度亦不相同,临床上以中毒性肝损伤导致死亡多见。云南省野生菌种类较多,也是毒蕈中毒的高发地区,每年夏季是发病高峰。2013年7-9月,我院急诊科收治急性重度毒蕈中毒病例10例,经抢救治疗均治愈,现报道如下。     

急性毒蕈中毒11例临床分析

毒蕈常被误采食用属常见的食物中毒.最近我院收治11例毒蕈中毒患者,现总结分析如下:     

毒蕈中毒所致急性肾衰25例治疗体会

本组报道三种疗法治疗毒蕈中毒所致急性肾功能衰竭(ＡＲＦ)２５例 ,治愈２１例 ,取得满意疗效 ,现总结如下 :１资料与方法１ １病例选择 :病例选自我院１９９５年以后住院的毒蕈中毒所至ＡＲＦ患者２５例 ,诊断均符合１９８２年全国危重病急救医学学术会议拟定的诊断标准。１ ２治疗分组 :药物治疗组 :９例 ,男４例 ,女５例 ,年龄１９～５２岁 ,平均血ＢＵＮ２３ ４ｍｍｏｌ／Ｌ，Ｃｒ６４５．８μｍｏｌ／Ｌ。血液透析(ＨＤ)组 :１０例 ,男４例 ,女６例 ,年龄２３～６４岁 ,平均血ＢＵＮ４０ ４ｍｍｏｌ／Ｌ ,Ｃｒ１０１８．７μｍｏｌ／Ｌ…     

严重毒蕈中毒3例报道

<正>1病例报道例1:患儿,男性,8岁,因"食毒蕈后出现腹痛伴巩膜黄染7d"于2008年6月2日入院。患儿7d前与其5个家人同吃自己采的6种野生蕈约0.5公斤混合煮的汤,吃后5h即出现恶心、呕吐,腹     

林芝地区急性毒蕈中毒78例临床分析

目的　探讨林芝地区毒蕈中毒的临床特征及治疗方法。　方法　对我院 2 0 0 3年 7～ 8月收治的78例毒蕈中毒患者进行临床分析。　结果　 77例患者以胃肠炎型为主 ,1例中毒患者因急性溶血、多脏器功能衰竭及出血倾向死亡。　结论　重视毒蕈中毒的临床特点 ,争取早期联合治疗 ,防止肝、肾等多脏器功能的损害     

12例急性毒蕈中毒的抢救与护理

目的针对急性毒蕈中毒典型病例,探讨急性毒蕈中毒临床表现以及诊疗措施,指导并提高急性毒蕈中毒的救治水平。方法对12例急性毒蕈中毒患者资料进行回顾性分析,根据患者的病情以及临床表现,总结抢救和护理经验,以提出可行性诊疗措施。结果 12例均有肝功能异常,3例死亡,9例痊愈。结论毒蕈中毒24h之内是抢救的关键;提高对毒蕈中毒的认识,发现症状,及时就医。     

急性毒蕈中毒62例临床分析

现将我院2004年7月～2006年8月诊治的毒蕈中毒62例分析如下。1资料与方法1.1诊断标准:所有病例都有误食毒蕈及食用未煮熟蕈类的病史,同食者均发病,伴毒蕈中毒的临床表现。胃内容物及残余物检验为毒蕈和未煮熟的蕈类。     

Suramin: potential in acute liver failure

Apoptosis is the first cellular response of the liver to many toxic events, including viral hepatitis, alcohol-induced liver disease and ischaemia/reperfusion injury. When apoptosis is induced with an antibody to APO-1, suramin is antiapoptotic in a variety of cell lines (e.g., Jurkat cells, HepG2). Jo2 is an antibody to mouse CD95, which kills C57Bl/6 mice, and was used as a model of fulminant liver failure in mice. Suramin protected 40% of Jo2-treated mice from death and delayed death in the other mice. In mice, D-galactosamine and endotoxin cause apoptotic liver damage, which is mediated by TNF. Suramin reduced this liver damage as assessed by serum aminotransferase levels, gross liver appearance and apoptosis levels. In contrast, suramin does not inhibit necrotic cell death in a rat model of liver transplantation. Inhibition of apoptosis with suramin or other more selective agents is an approach that should be further investigated in liver failure.     

急性肝衰竭时催乳素变化的实验研究

目的探讨急性肝衰竭大鼠催乳素变化及雌二醇对该变化的影响。方法Wistar雄性大鼠被随机分成三组,正常组(对照组),硫代乙酰胺(thioacetamide,TAA)组,苯甲酸雌二醇加硫代乙酰胺(TAA E2)组。TAA组、TAA E2组大鼠用硫代乙酰胺(600 mg.kg-1)间隔24 h两次皮下注射,复制大鼠急性肝衰竭的动物模型,TAA E2组同时皮下注射苯甲酸雌二醇注射液。对照组以同样方法皮下注射生理盐水。1 d后眼球取血,离心后放射免疫法观察血清PRL及雌二醇(E2)浓度。结果TAA、TAA E2两组血清PRL浓度与对照组相比有明显变化(P<0.05),但TAA组与TAA E2组之间血清PRL浓度无变化(P>0.05),TAA组与E2 TAA组血清雌二醇存在差异(P<0.05)。结论TAA诱导急性肝衰竭时,血清PRL可升高,但不受外源雌二醇影响。     

猪再生肝肝细胞生长因子治疗急性肝衰竭大鼠的实验研究

目的研究猪再生肝肝细胞生长因子 (PRHGF)对急性肝衰竭的治疗作用。方法采用硫代乙酰胺 (TAA)灌胃造成大鼠急性肝衰竭 ,PRHGF腹腔给药 ,观察其治疗作用。结果PRHGF能显著提高急性肝衰竭大鼠存活率 ,降低肝衰竭大鼠血清总胆红素含量、丙氨酸转移酶活性及肿瘤坏死因子的含量 ,与模型组比较差异显著 (P <0 .0 5 ) ;并能明显减少肝细胞坏死 ,促进肝细胞再生。结论PRHGF对TAA所致大鼠急性肝衰竭具有显著的治疗作用     

头孢拉定致急性肝衰竭

1名30岁男性患者,因上呼吸道感染未行皮试而静脉滴注头孢拉定1.0g。0.5h后出现全身皮疹伴瘙痒,经抗过敏治疗后稍缓解。第3天患者出现乏力、食欲不振、恶心,尿色深,皮肤、巩膜黄染。实验室检查:ALT235.4U/L,AST264.1U/L,γ-GT175.5U/L,ALP239U/L,TBil283.7μmol/L,DBil176.2μmol/L,CHE2153U/L,Cr271.2μmol/L。给予保肝、抗炎及对症治疗,40d后患者症状消退,血生化检查恢复正常。     

急性有机磷农药中毒致呼吸衰竭的机械通气治疗32例

收集1998年2月～2001年12月于我科施行机械通气抢救的32例有机磷中毒呼吸衰竭病例,其中重度中毒27例,中度中毒5例,平均年龄32.5岁,结果32例中4例死亡,抢救成功率88%,机械通气时间3～15 d,平均6.5 d.提出:尽早建立合理人工气道,选择正确通气方式,随时调节呼吸参数,及时处理脑水肿,加强呼吸道管理的各环节力度,保证能量供应,减少医源性呼衰因素,注意机械通气并发症等综合处理是成功的关键.     

MARS人工肝治疗肝衰竭的临床探讨

目的 探讨肝衰竭病人MARS人工肝治疗的最佳时机、治疗次数、每次治疗时间及疗效。方法 将接受MARS治疗的肝衰竭病人152例,按MARS治疗的次数分为单次MARS治疗组42例,多次MARS治疗组印例,内科治疗对照组50例。观察MARS治疗前后临床症状的改变,对比分析MARS治疗前及治疗6,7,8h的相关实验室数据。比较单次MARS治疗组、多次MARS治疗组和对照组的生存率,以及死亡病例的特点。结果 MARS人工肝治疗能有效改善肝衰竭病人的临床症状。明显提高病人的生存率（P〈0．05）,无明显合并症者治疗效果好,连续多次的MARS治疗病人的预后可得到进一步的改善。出现多个并发症时．无论MARS人工肝治疗还是内科加强治疗,病死率均明显增加。MARS治疗时间6,7。8h在毒索的清除上无显著性差异（P〈0．05）。结论 MARS治疗时机应尽量选择早期无并发症时,特别危重的病人应进行多次MARS人工肝治疗,间歇期不应过长（24-48h）。每次MARS治疗的时间以6h为宜．     

Acute Liver Failure after Ingestion of Fried Rice Balls: A Case Series of Bacillus cereus Food Poisonings

Bacillus cereus foodborne intoxications and toxicoinfections are on a rise. Usually, symptoms are self-limiting but occasionally hospitalization is necessary. Severe intoxications with the emetic Bacillus cereus toxin cereulide, which is notably resistant heat and acid during cooking, can cause acute liver failure and encephalopathy. We here present a case series of food poisonings in five immunocompetent adults after ingestion of fried rice balls, which were massively contaminated with Bacillus cereus. The patients developed a broad clinical spectrum, ranging from emesis and diarrhoea to life-threatening acute liver failure and acute tubular necrosis of the kidney in the index patient. In the left-over rice ball, we detected 8 × 10⁶ Bacillus cereus colony-forming units/g foodstuff, and cereulide in a concentration of 37 μg/g foodstuff, which is one of the highest cereulide toxin contaminations reported so far from foodborne outbreaks. This report emphasizes the potential biological hazard of contaminated rice meals that are not freshly prepared. It exemplifies the necessity of a multidisciplinary approach in cases of Bacillus cereus associated food poisonings to rapidly establish the diagnosis, to closely monitor critically ill patients, and to provide supportive measures for acute liver failure and—whenever necessary—urgent liver transplantation.     

卡培他滨引起急性肾衰竭

1名94岁男性直肠腺癌患者接受卡培他滨化疗。在第3周期给予卡培他滨1500mg,2次/d,用药12d后,患者出现嗜睡、心慌、发热,血Cr由145μmol/L上升到173μmol/L,BUN由10.9mmol/L上升到27.4mmol/L,立刻停药。6d后,SCr310μmol/L,BUN62.5mmol/L。给予复方α-酮酸、利尿剂、低蛋白饮食等治疗,SCr及BUN逐渐下降。4个月后复查,SCr及BUN恢复正常。     

肝衰竭患者人工肝血浆置换前后凝血功能指标变化观察

目的观察肝衰竭患者人工肝血浆置换治疗前后凝血功能的变化。方法42例肝衰竭患者在综合治疗的基础上进行人工肝血浆置换治疗,在人工肝血浆置换治疗前后检测血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、血浆凝血酶时间（TT）、凝血酶原活动度（PTA）、血浆抗凝血酶Ⅲ（AT-Ⅲ）、国际标准化比值（INR）、纤维蛋白原（Fbg）。结果治疗后PT、INR、AT-Ⅲ均有明显改善（P〈0．05）,而Fbg、APTY、TT、PTA无显著改善（P〉0．05）。结论人工肝血浆置换治疗能部分改善肝衰竭患者的凝血功能。     

Intra-abdominal hypertension is an independent cause of acute renal failure after orthotopic liver transplantation

An independent association between acute renal failure (ARF) and intra-abdominal hypertension (IAH) after liver transplantation has not been established previously. The aim of this retrospective study was to understand the role of IAH as an independent risk factor for ARF in the early postoperative period. This study involved 62 subjects who underwent liver transplantation. Intra-abdominal pressure (IAP) was measured in the first three days after surgery by using the urinary bladder technique. An IAP of at least 20 mmHg per day was defined as IAH. Clinical parameters between group IAH and group NO-IAH were compared in terms of the incidence of ARF, blood creatinine levels, blood urea nitrogen (BUN) levels, urine volume per hour and glomerular filtration gradient (GFG). Hemodynamic variations were recorded in the first three postoperative days between group ARF and group NO-ARF. The perioperative suspected risk factors of ARF were determined for statistical evaluation using correlation coefficients and logistic regression analysis. In group IAH, 45.8% patients developed ARF as against 7.9% in group NO-IAH; GFG was significantly lower at 0–72 h after surgery; and blood creatinine levels, BUN levels, urine volume per hour were significantly different at 24–72 h after surgery compared with group NO-IAH. The patients with ARF were not significantly different from those without ARF in terms of central venous pressure, pulmonary artery pressure and mean arterial pressure (MAP) in the first three postoperative days despite a significant increase in heart rate at 24–72h after operation. Postoperative IAH, intraoperative MAP and intraoperative blood transfusion volume of more than 15 U were found to be independent risk factors for ARF. IAH impaired renal function and was an independent risk factor for ARF after liver transplantation. Routine measurement should be taken to monitor IAP every eight hours postoperatively. Translated from Chinese Journal of Organ Transplantation, 2006, 27(1): 22–25 [译自: 中华器官]