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中毒是日常生活中常见的突发事件,近年来有发生率增高的趋势.特别是一氧化碳(CO)等有害气体,是秋冬季中毒的主要原因.     

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??Abstract??The treatment of acute poisoning has always been a challenge in modern medicine??because there are so many types of poisonous materials and the poisoning individual varies??and the detoxification drugs with special effects are lacking.Extracorporal blood purification has an established role in the treatment of various intoxications.Hemoperfusion??hemodialysis??hemofiltration and plasmapheresis are effective methods for removal of toxin from the body and usually applied in selected cases of diagnosed severe forms as the options of fast elimination of the intoxicating agent.With the improvement of blood purification techniques and new life supporting systems??their clinical applications are rapidly increasing in number and scope.These methods have been applied whenever certain potentially lethal intoxications are diagnosed and/or suspected??even without evidence of life impediment at the time of institution of therapy.However??the large and high quality controlled trials are needed to prove the clear elimination of each type of intoxication by extracorporal blood purification techniques.     

血液净化治疗重症药物及毒物中毒15例

目的总结应用血液净化治疗重症药物及毒物的经验。方法对应用日本JMSSDS-20透析机进行血液净化治疗的15例重症药物及毒物中毒病人的临床资料进行回顾性分析。结果全组15例中14例（93．3％）治愈，1例死亡，血液净化治疗27例次，无不良反应。结论血液净化治疗重症药物中毒及毒物中毒效果良好、设备简单，适合县市级医院开展。     

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近年来,群体性急性、慢性中毒事件在全国范围内时有发生,作为医务人员应不断学习中毒与解救知识,提高处理群体中毒事件的能力。1群体中毒的概念、原因及特点群体中毒是指在一定时间内,在某个相对集中的区域内,因食入或吸入特定有毒物质后,同时或相继出现3例及以上相同临床症状、体征者称群体中毒。其常见于食物中毒、生产性毒物中毒、生产中的意外事故、恶性投毒事件以及救治群体中毒患者时发生的医源性药物中毒等。群体中毒事件具有突发性、群体性、复杂性、紧迫性、共同性、艰巨性的特点。因此,国家卫生部应急办公室要求重特大中毒事件必…     

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1概述世界上已知的蛇类有2700多种,其中毒蛇600多种。在有毒动物导致的人类中毒病例中,毒蛇咬伤(venomoussnake bite)占首要位置,全世界每年蛇咬伤的人数达50万,其中死亡3万~4万。我国已发现毒蛇50余种,存在剧毒、危害大的蛇类主要有眼镜蛇科(眼镜蛇、眼镜王蛇、金环蛇、银环蛇     

血液灌流抢救重度中毒24例体会

随着血液净化技术的发展和逐步提高，血液灌流技术在临床中已被广泛应用，尤其是在抢救药物和毒物中毒中起着至关重要的作用。我院自2004年6月开展此项技术，至2005年12月止用于抢救各种重度中毒患者24例，现分析报告如下。     

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百草枯(paraquat)为联吡啶类除草剂,化学名为1,1′-二甲基-4,4′联吡啶阳离子盐。随着百草枯在农业生产中的广泛应用,中毒事件日渐增多。虽然有关百草枯中毒的研究很多,但临床治疗效果仍然不能令人满意,病死率通常达50%~80%。结合笔者自身体会,现就百草枯中毒救治中的有关问题加以讨论。1百草枯中毒的诊断百草枯可以经消化道、皮肤和呼吸道吸收。一般情况下,完整的皮肤能够有效阻止百草枯的吸收,但长时间接触,如穿被百草枯溶液污染的衣服,阴囊或会阴部被污染,破损的皮肤大量接触,大面积皮肤被浓缩液污染,仍有可能造成全身毒性。百草枯不挥发…     

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毒蕈又称为毒蘑菇、毒菌、毒茸等.全世界已知的毒蕈有百余种,目前在我国已发现80余种,能威胁人类生命的有20余种,极毒者有10种左右.本文仅就毒蕈中毒的早期识别及处理作一概述.     

血液净化抢救急性重症中毒29例分析

2003年3月-2005年11月我科利用血液透析（HD）与血液灌流（HP）技术抢救29例重症急性中毒患者，取得了良好的治疗效果，现总结如下。     

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1995年,第一届国际连续性肾脏替代治疗会议首次提出了连续性肾脏替代治疗(continuous renal replacementtherapy,CRRT)的概念,即任何一种旨在替代受损的肾脏而进行的、持续至少24h的体外血液净化治疗技术。近年来,CRRT技术发展迅速,已经从单纯的肾脏替代治疗扩展到多器官功能的     

Hemoperfusion in the treatment of acute valproic acid intoxication

Valproic acid is increasingly used in the treatment of epilepsy, and also prescribed for bipolar affective disorders, schizoaffective disorders, schizophrenia and migraine prophylaxis. Valproic acid intoxication with suicide attempt is a relatively common clinical problem that can result in coma, respiratory depression, pancytopenia, hemodynamic instability and death. The drug's relatively low molecular weight, small volume of distribution and saturable protein-binding render it potentially amenable to exracorporeal removal (hemodialysis, hemoperfusion or hemofiltration ), but published experience is scarce. We describe a case report involving valproic acid intoxication with ingestion of ethanol, who was successfully treated with charcoal hemoperfusion. With this treatment the half-life of valproic acid was reduced with rapid lowering of valproic acid levels and clinical improvement. Based on our experience in this patient and a review of previously reported cases, charcoal hemoperfusion should be considered for serious valproic acid intoxication because free as well as bound drug fractions are eliminated via this technique.     

Evaluation of blood purification and bortezomib plus dexamethasone therapy for the treatment of acute renal failure due to myeloma cast nephropathy

Aggressive removal of circulating free light chains (FLC) by blood purification accompanied by chemotherapy is a promising approach for the treatment of acute renal failure due to myeloma cast nephropathy. Plasma exchange has been performed to remove serum FLC; in order to examine an alternative strategy we performed hemodiafiltration using protein-leaking dialyzers for the treatment of dialysis-dependent acute renal failure due to myeloma cast nephropathy. In the first case with κ-light chain cast nephropathy, the pre-treatment serum creatinine was 9.65 mg/dL, and the serum κ-FLC was 27100 mg/L. Plasma exchange or hemodiafiltration was performed from Monday to Friday during the first several weeks. Chemotherapy was started with high-dose dexamethasone and then switched to bortezomib plus dexamethasone. The mean removal rates of κ-FLC were 45.8% (one plasma volume) and 66.9% (one-and-a-half plasma volumes) by plasma exchange. The removal rates of κ-FLC by hemodiafiltration (66.9%, FB210UHβ; 71.6%, PES210Dα; 75.2%, FXS220) were comparable to those by plasma exchange. In the second case with λ-light chain cast nephropathy, the pre-treatment serum creatinine was 4.14 mg/dL, and the serum λ-FLC was 4140 mg/L. The mean removal rates of λ-FLC were 60.2% (FXS140) and 64.2% (FB210UHβ) by hemodiafiltration. Both cases became dialysis-independent. The combination of an intense blood purification regimen and bortezomib plus dexamethasone therapy appears to be an efficient approach to renal recovery. Hemodiafiltration using protein-leaking dialyzers could become an alternative to plasma exchange as a method of removing FLC.     

Appropriate treatment of acute sigmoid volvulus in the emergency setting

AIM:To investigate an appropriate strategy for the treatment of patients with acute sigmoid volvulus in the emergency setting.METHODS:A retrospective review of 28 patients with acute sigmoid volvulus treated in the Department of Colorectal Surgery,Changhai Hospital,Shanghai from January 2001 to July 2012 was performed.Following the diagnosis of acute sigmoid volvulus,an initial colonoscopic approach was adopted if there was no evidence of diffuse peritonitis.RESULTS:Of the 28 patients with acute sigmoid volvulus,19(67.9%)were male and 9(32.1%)were female.Their mean age was 63.1 ± 22.9 years(range,21-93 years).Six(21.4%)patients had a history of abdominal surgery,and 17(60.7%)patients had a history of constipation.Abdominal radiography or computed tomography was performed in all patients.Colonoscopic detorsion was performed in all 28 patients with a success rate of 92.8%(26/28).Emergency surgery was required in the other two patients.Of the 26 successfully treated patients,seven(26.9%)had recurrent volvulus.CONCLUSION:Colonoscopy is the primary emergency treatment of choice in uncomplicated acute sigmoid volvulus.Emergency surgery is only for patients in whom nonoperative treatment is unsuccessful,or in those with peritonitis.     

Pamidronate treatment in acute vitamin D intoxication

Management with glucocorticoid, high iv fluid saline intake, furosemide and calcitonin may not result in a favorable reduction of hypercalcemia and may cause several side effects in infants with acute vitamin D intoxication. The bisphosphonate pamidronate, a specific inhibitor of bone resorption through osteoclast mediation was successfully used in a 6-month old infant with acute vitamin D intoxication managed in the Pediatric Emergency and Intensive Care Unit, after an ineffective trial of hydration, furosemide, calcitonin and prednisolone. After a double infusion of pamidronate on two consecutive days (1 mg/kg/day), an early and safe correction of hypercalcemia/hypercalciuria was supplied. Pamidronate therapy may be considered in patients with hypercalcemia secondary to acute vitamin D poisoning.     

Insulin or blood purification treatment for hypertriglyceridaemia-associated acute pancreatitis: A systematic review and meta-analysis

Background/objectivesHypertriglyceridaemia increases risks from acute pancreatitis (HTG-AP) over other aetiologies, but optimal management for HTG-AP remains undefined. We performed a systematic review and meta-analysis of studies of insulin-based treatment (IT) versus blood purification treatment (BPT) for HTG-AP.MethodsSearches were conducted to identify randomised trials and observational studies published between 1946 and 2022 that compared IT and BPT for HTG-AP reporting baseline and post-treatment serum triglyceride (TG) levels with clinical outcomes. The primary outcome was serum TG reduction (Δ-TG) from baseline while secondary outcomes included complications, length of stay, adverse events, and cost.ResultsFifteen (1 randomised, 2 prospective case-controlled, and 12 retrospective cohort) studies were analysed comprising 909 cases with HTG-AP. Pooled results demonstrated IT was significantly less efficient than BPT in Δ-TG at 24 h (WMD -666.06, 95% CI -1130.18 to ?201.94, P = 0.005; 12 studies), at 48 h (WMD -672.60, 95% CI -1233.44 to ?111.77; 8 studies), and overall Δ-TG by day 7 (WMD -385.81, 95% CI -711.07 to ?60.54; 8 studies) (both P = 0.02). IT, however, was associated with significantly fewer adverse events (OR 0.09, 95% CI 0.03 to 0.27, P < 0.0001; 7 studies) and significantly reduced cost (WMD -2.50, 95% CI -3.61 to ?1.39, P < 0.00001; 3 studies). Other secondary outcomes were not significantly different between the two regimens (all P ≥ 0.11). In subgroup analysis Δ-TG at 24 h and overall Δ-TG became insignificant, while other results were unaffected.ConclusionOur findings support the general use of IT for inpatient management of HTG-AP, restricting BPT to those predicted or found to respond poorly to IT.     

早期连续性血液净化治疗重症急性胰腺炎14例

目的:探讨早期连续性血液净化(continuous blood purification,CBP)治疗重症急性胰腺炎(severe acute pancreatitis,SAP)的临床疗效.方法:选取符合SAP诊断且年龄18-65岁的住院患者,自愿行早期(起病48h内)CBP治疗的患者纳入试验组,其余患者纳入对照组.所有患者均按指征接受机械辅助呼吸、肠外营养、抗感染、血管活性药物、生长抑素、抗弥漫性血管内凝血等治疗.试验组病例在确诊SAP后8h内开始连续性血液净化治疗.比较2组患者在治疗前、治疗后1、3、5d的APACHEⅡ评分、血浆TNF-α检测值逐渐变化的差异性.在同一组患者中,比较相邻2d的APACHEⅡ评分值的差异性.结果:试验组病例在CBP治疗后,患者症状体征明显改善,治疗后1、3、5d APACHEⅡ评分、血浆TNF-α检测值与对照组比较,差异有显著性意义(APACHEⅡ评分:15.93±4.81vs18.50±4.77,13.71±4.01vs18.08±4.83,10.79±2.39vs15.17±4.59;TNF-α:60.00±15.27vs89.08±25.56,42.14±6.94vs89.83±23.19,39.00±6.04vs80.00±23.02,均P<0.05);试验组病例治疗后1、3、5d APACHEⅡ评分、血浆TNF-α检测值较治疗前显著下降,差异有显著性(P<0.05).结论:早期CBP治疗可显著改善SAP患者的临床症状,保护器官功能,改善预后,降低病死率.