血液灌流与血液透析联合应用治疗重度有机磷农药中毒

我院自2002年1月至2006年10月对11例口服有机磷农药急性中毒患者采用血液灌流联合血液透析治疗,疗效显著,现报道如下。[第一段]     

血液灌流治疗急性重度有机磷农药中毒疗效观察

目的总结血液灌流治疗急性重度有机磷农药中毒的疗效和经验。方法对在常规治疗上加用血液灌流治疗的24例急性重度有机磷农药中毒患者的临床资料进行回顾性分析,并以22例采用常规治疗的病例作对照。结果血液灌流治疗组患者昏迷至清醒时间、胆碱酯酶恢复时间和平均住院时间都明显短于对照组,治愈率高于对照组,死亡率低于对照组,两组差异有统计学意义（P〈0.05）。结论血液灌流治疗急性有机磷农药中毒效果肯定,能提高抢救成功率,降低死亡率。     

血液灌流辅助抢救急性重度有机磷农药中毒的疗效观察

目的探讨血液灌流（HP）辅助抢救急性重度有机磷农药中毒（ASOPP）疗效。方法根据时间段将ASOPP患者分为观察组（46例）和对照组（20例），两组均常规采用内科抢救治疗方法，观察组在此基础上加用HP治疗。结果观察组治愈率显著高于对照组（P〈0．05），而病死率、并发症发生率及阿托品总用量显著低于对照组（P〈0．01，P〈0．05）；患者昏迷时间、住院时间显著较对照组短（P〈0．01．P〈0．05）。结论系统内科治疗辅助HP，可提高ASOPP患者治愈率，降低病死率及并发症发生率；严密的病情观察及护理是抢救成功的关键。     

血液灌流治疗重度有机磷中毒的临床观察

目的 探讨血液灌流治疗急性重度有机磷中毒的时机与疗效.方法 68例急性重度有机磷中毒患者分为治疗组和对照组,治疗组38例患者采用常规内科治疗联合血液灌流;对照组30例患者采用常规内科治疗,治疗组按行血液灌流时间不同分为3组,观察各组治疗效果.结果 治疗组与对照组患者入院48h血胆碱酯酶水平比较差异有统计学意义(P＜0.05);阿托品总用量各组比较差异无统计学意义(P＞0.05);各组住院时间比较差异有统计学意义(P＜0.05);各组治愈率和病死率比较差异也有统计学意义(P＜0.05);治疗组与对照组患者呼吸衰竭发生率及病死率比较差异有统计学意义(P＜0.05),其余并发症发生率比较差异无统计学意义(P＞0.05);两两比较 q 检验提示治疗 A 组血胆碱酯酶恢复较对照组快,住院时间较其他组短.结论 血液灌流能及时清除血液中的有机磷,使患者的血胆碱酯酶快速恢复,提高治愈率、缩短住院时间,降低病死率;越早治疗疗效越好.     

血液灌流辅助抢救急性重度有机磷农药中毒的疗效观察

目的探讨血液灌流(HP)辅助抢救急性重度有机磷农药中毒(ASOPP)疗效。方法根据时间段将ASOPP患者分为观察组(46例)和对照组(20例),两组均常规采用内科抢救治疗方法,观察组在此基础上加用HP治疗。结果观察组治愈率显著高于对照组(P<0.05),而病死率、并发症发生率及阿托品总用量显著低于对照组(P<0.01,P<0.05);患者昏迷时间、住院时间显著较对照组短(P<0.01,P<0.05)。结论系统内科治疗辅助HP,可提高ASOPP患者治愈率,降低病死率及并发症发生率;严密的病情观察及护理是抢救成功的关键。     

血液灌流联合血液透析治疗重度有机磷农药中毒40例临床分析

目的 分析血液灌流联合血液透析治疗重度有机磷农药中毒疗效和安全性.方法 回顾性分析2006年1月至2009年4月收治的40例重度有机磷农药中毒患者行血液灌流联合血液透析治疗的临床资料.结果 40例重度有机磷农药中毒患者行血液灌流联合血液透析治疗后,有36例痊愈,4例死亡.40例患者中有2例出现中间综合征,继续多次行血液灌流联合血液透析治疗后痊愈.40例患者中有1例患者因原有胃黏膜损伤而出现消化道出血.结论 血液灌流联合血液透析治疗重度有机磷农药中毒疗效可靠安全、能提高抢救成功率、减少中毒后遗症,且安全性好.     

血液灌流治疗急性有机磷中毒的临床观察

目的 探讨血液灌流抢救急性有机磷中毒的临床疗效观察.方法 应用单泵和血液灌流器对急性有机磷中毒的患者行血液灌流治疗.结果 6例急性重度有机磷农药中毒患者经过血液灌流治疗后于30 min～24 h内意识渐清楚,治疗过程中1例患者因气管插管呼吸机辅助机械通气治疗后好转.结论 血液灌流抢救治疗急性有机磷中毒疗效显著.     

血液灌流抢救重度急性有机磷中毒的疗效观察

目的：探讨血液灌流（HP）抢救重度急性有机磷农药中毒（AOPP）的疗效及影响因素。方法：将64例重度AOPP病人随机分为观察组和对照组各32例，观察组在常规治疗基础上行血流灌流治疗，对照组按常规治疗，观察两组病人的治疗效果。结果：观察组清醒时间和达阿托品化的时间缩短，血清胆碱脂酶（ChE)恢复活力时间明显较对照组缩短（P＜0．05）；阿托品用量较对照组减少1／3（P＜0．05）；观察组痊愈27例，自动出院5例，痊愈率与对照组比较，差异有显著性意义（P＜0．05）。结论：重度AOPP病人在常规治疗的同时，早期给予HP治疗可提高抢救成功率。     

血液灌流抢救重症有机磷中毒临床疗效观察

有机磷农药大多数属有机磷酸酯或硫代磷酸酯类化合物 ,是目前应用最广泛的农药。由于预防不当 ,很容易引起中毒 ,危及生命。重症有机磷中毒 (ＡＯＰＰ)的抢救 ,在基层医院最常见 ,虽然随着阿托品用量的增加 ,有机磷农药中毒患者抢救成功率明显提高 ,但重度有机磷农药中毒患者死亡率仍很高。我院自 1998年以来 ,在ＡＯＰＰ抢救过程中 ,采用以ＨＰ配合阿托品及ＣＨＥ复能剂 ,取得满意的疗效 ,报告如下。资料与方法1　一般资料　ＨＰ治疗组 :本院从 1998年～ 2 0 0 2年收治ＡＯＰＰ病人 30例 ,其中男 11例 ,女 19例 ;均为口服中毒或皮肤吸收中…     

血液灌流治疗急性有机磷农药中毒中间综合征的疗效研究

目的 探讨血液灌流对急性有机磷农药中毒中间综合征（ＩＭＳ）患者血中有机磷的清除作用及临床疗效。方法 ２０例ＩＭＳ患者随机分为灌流组和非灌流组。灌流组在综合治疗基础上,除用解磷定外,同时予以血液灌流治疗,并用固相萃取技术进行色谱定量分析灌流前后患者血中有机磷含量。非灌流组在综合治疗基础上单用解磷定。通过观察灌流前后血中有机磷含量的变化、存活率、ＩＭＳ病程及呼吸肌麻痹发生率４项指标来判断血液灌流的临床     

血液灌注和血浆置换联合熊去氧胆酸治疗慢性重型肝炎疗效观察

在人工肝研究领域,血液灌注、血浆置换等技术和方法被称为非生物人工肝,系主要通过其机械性血液净化原理清除患者体内的毒性物质,达到治疗肝衰竭的目的.研究发现,熊去氧胆酸具有拮抗巯水性胆酸的细胞毒性作用,促进内源性胆汁酸排泄并抑制其吸收,抑制细胞凋亡、抗氧化、调节免疫和抑制炎症等作用.本研究对血液灌注和血浆置换两种典型非生物型人工肝联合熊去氧胆酸,通过清除重型肝炎患者体内的损肝物质达到改善肝脏功能进行初步观察.     

盐酸戊乙奎醚用于重度有机磷中毒的救治

目的比较盐酸戊乙奎醚与阿托品在救治重度有机磷中毒中的疗效。方法以作者及所在科室既往救治的重度有机磷中毒患者作为对照组,选择新就诊的重度有机磷中毒患者作为治疗组,以盐酸戊乙奎醚替代阿托品作为抗胆碱药物,比较两组的治愈率、病死率、严重并发症的发生率及严重并发症的病死率等。结果对照组总治愈率为80·0%,总病死率为20·0%,中毒治疗时间平均为8·3d,严重并发症的发生率为73·3%,严重并发症的病死率为27·3%。治疗组总治愈率为94·7%,总病死率为5·3%,中毒治疗时间平均为10·2d,严重并发症发生率为47·4%,严重并发症的病死率为11·1%。两组间治愈率、总病死率及严重并发症发生率有显著性差异(P<0·05)。两组间严重并发症的病死率及平均中毒治疗时间上无显著性差异。结论与阿托品相比,盐酸戊乙奎醚能进一步减少严重并发症的发生,降低死亡率,提高治愈率。     

连续性血液净化治疗急性有机磷农药中毒的疗效观察

目的分析研究连续性血液净化对急性有机磷农药中毒患者的治疗效果及安全性。方法选择2008年1月～2013年9月我院急性有机磷农药中毒患者共70例为临床研究对象,将患者分为两组。对照组患者给予临床常规治疗,实验组患者给予HP＋CVVH序贯治疗,观察比较两组患者的治疗过程中发生低氧血症、呼吸衰竭、脏器损伤及死亡率和患者血清SOD等指标。结果实验组患者发生低氧血症、呼吸衰竭、脏器损伤低于对照组患者,死亡率低于对照组患者,差异有统计学意义（P〈0．05）。实验组患者治疗后血清hs—CRP水平更低,胆碱酯酶活性优于对照组患者,差异有统计学意义（P〈0．05）。结论使用连续性血液净化对急性有机磷农药中毒具有较好的效果,可以有效地降低患者的死亡率,减轻患者的损伤。     

Therapeutic effect of daytime continuous blood purification combined with plasma exchange on non-biliary severe acute pancreatitis

Objective To investigate the clinical efficacy of daytime continuous blood purification (DCRRT) combined with plasma exchange in the treatment of severe acute pancreatitis. Methods The clinical data of 49 patients with non-biliary severe acute pancreatitis admitted to the First People's Foshan Hospital from January 2012 to January 2019 were analysed respectively. The enrollees were randomized into DCRRT combined with plasma exchange (combination therapy) group and DCRR only (DCRR) group using a random number table method. All patients received DCRRT therapy [8 hours continuous venous-venous blood purification/day (CVVH/d)] immediately after the diagnosis of non-biliary severe acute pancreatitis was established. The combination group received at least one plasma exchange during the course of treatment. The differences of laboratory examination and prognosis between the two groups before and after treatment were compared. Results A total of 49 patients were enrolled, including 29 males and 20 females, with age of (46.40±17.81) years. There were 24 patients in the combination therapy group and 25 patients in DCRR group. There were no significant differences in the age, gender, body mass index (BMI), and pre-treatment laboratory findings between the two groups. After treatment, the blood glucose, hypersensitive C-reactive protein (hs-CRP), procalcitonin (PCT-u), amylase, lipase, triglyceride, cholesterol, serum creatinine were lower than those before treatment (all P＜0.05). The blood hs-CPR, PCT-u, lipase and triglyceride in the combination therapy group were significantly lower than those in the DCRR group (all P＜0.05). The acute physiology and chronic health scores (APACHEⅡ) of the two groups were lower than those before treatment, and the combination therapy group was more significant than DCRR group (all P＜0.05). There were 5 deaths (20.83%) in the combination therapy group and 7 deaths (28.00%) in DCRR group. There was no significant difference in mortality between the two groups. There was no significant difference in the start time and duration of DCRRT between the two groups. Conclusions DCRRT or combined plasma exchange therapy can effectively treat non-biliary severe acute pancreatitis. DCRRT combines with plasma exchange therapy can more effectively remove inflammatory factors and reduce APACHEⅡ score.     

Immunoglobulin treatment versus plasma exchange in patients with chronic moderate to severe myasthenia gravis

The purpose of this study was to compare the efficacy of high-dose intravenous immunoglobulin (IVIG) treatment with plasma exchange in patients suffering from moderate to severe myasthenia gravis (MG) in a stable phase. There are no controlled studies comparing IVIG with plasma exchange in patients who despite immunosuppressive treatment have persistent incapacitating MG symptoms. This was a controlled crossover study. Twelve patients with generalized moderate to severe MG on immunosuppressive treatment for at least 12 months were included. The patients were evaluated clinically using a quantified MG clinical score (QMGS) before and at follow-up visits after each treatment. One week after the treatments, the patients who received plasma exchange treatment showed a significant improvement in QMGS compared to baseline but although some improvement was seen after IVIG this did not reach statistical significance. Four weeks after both plasma exchange and IVIG treatments, there was a significant improvement in QMGS compared to baseline. One week and 4 weeks after treatment, no significant difference between the 2 treatments was found. Both treatments have a clinically significant effect 4 weeks out in patients with chronic MG, but the improvement has a more rapid onset after plasma exchange than after IVIG.     

Early high-intensity blood purification for severe wasp venom poisoning with acute kidney injury

Objective To evaluate the safety and efficacy of early high intensity blood purification for severe wasp venom poisoning with acute kidney injury (AKI). Method We retrospectively analyzed 120 patients [(47±14) year, F/M=68/52] with severe wasp venom poisoning (creatine kinase >20,000 IU/L; lactic dehydrogenase >5000 IU/L) and AKI who were admitted during 2012-2014 to West China Hospital of Sichuan University, Jianyang People's Hospital of Sichuan Provinces, Ziyang First People's Hospital of Sichuan Provinces and Anyue People's Hospital of Sichuan Provinces. According to the intensity of blood purification, patients were divided into early high intensity group and conventional group. Patients in early high intensity group received plasmapheresis 1 to 3 times, and continuous renal replacement therapy (CRRT) for at least 48h, and then intermittent hemodialysis (IHD) was performed when patients became stable. Patients in conventional group received IHD 3 to 6 times per week. Meanwhile, all patients received glucocorticoid, blood transfusion and fluid support if necessary. We collected all possible clinical and laboratory data. The primary outcomes were survival rate and kidney function. Results Early high intensity therapy was associated with higher survival rate compared with conventional therapy (92.6% vs 74.2%, P=0.02). Among survival patients, 3 patients (5.6%) in early high intensity group were progressed to chronic kidney disease (CKD); instead, 11 patients (16.7%) in conventional group were progressed to CKD, indicating significant difference between two groups (P=0.04). Moreover, the duration of blood purification was significantly shorter in early high intensity group in comparison with conventional group (19.5±6.2 vs 28.1±13.4 d, P＜0.05). Conclusions Early high intensity blood purification may increase the survival rate of patients with severe wasp venom poisoning and AKI, and may reduce the incidence of CKD.     

Efficacy of nafamostat mesilate as a regional anticoagulant in experimental direct hemoperfusion and in plasma exchange on humans

As an anticoagulant, we compared Nafamostat mesilate (FUT) to heparin in experimental direct hemoperfusion (DHP) and studied the efficacy of FUT in clinical plasma exchange (PE). In in vitro study, FUT (5 micrograms/ml) inhibited the activation of C4 more strongly than heparin (100 U/h), and larger dose of FUT (50 micrograms/ml) inhibited the activation of C3. Experimental DHP with FUT on jaundiced dogs was safely performed, but not with heparin. Clinical PE with FUT was safely performed and the hemostatic condition was not aggravated either during or after PE in patients with bleeding.