1例CRRT联合HP治疗蝮蛇咬伤的护理简

蝮蛇是我国剧毒蛇类中分布最广的一种,蝮蛇毒为混合毒,兼有神经、血液毒素为特点,以血液毒素为主,进入人体后迅速引起严重的全身中毒症状而危及生命。我科于2012年8月23日收治1例腹蛇咬伤患儿,采用连续性肾脏替代治疗（CRRT ）联合血液灌流（H P ）治疗,通过精心、细致的护理,疗效明显,治愈出院。现将护理报告如下。     

血液净化对高脂血症性重症胰腺炎预后的影响

目的：探讨血液灌流（HP）联合高通量血液滤过（HVHF）对并发高脂血症的重症急性胰腺炎（SAP）患者预后的影响。方法：回顾性分析我院重症医学科44例并发高脂血症的SAP患者,根据治疗方法不同分为治疗组（24例）和对照组（20例）。治疗组在常规治疗基础上早期进行HP联合HVHF治疗,对照组应用常规治疗。对治疗前后患者APACHE-Ⅱ评分、相关生化指标及预后指标进行比较。结果：两组患者治疗前各观察指标比较差异无统计学意义,两组患者治疗后各观察指标与治疗前比较均有好转（P〈0.05）,治疗组APACHE-Ⅱ评分及相关生化指标较对照组治疗后改善明显（P〈0.05）,治疗组较对照组住院时间缩短,生存率高。结论：HP联合HVHF可有效缓解并发高脂血症的SAP患者病情,改善其预后。     

SUCCESSFUL TREATMENT OF ACUTE DAPSONE INTOXICATION USING CHARCOAL HEMOPERFUSION

Abstract: A 22 year old female was admitted to hospital two hours after ingesting 4 g of dapsone. Over the next 15 h she developed progressive hemolysis and methemoglobinemia. Charcoal hemoper-fusion and sequential dialysis were performed because of the serious risk of fatality following such a massive dose of dapsone. Charcoal hemoperfusion led to rapid clearing of dapsone from the circulation. This resulted in clinical improvement and controlled the progression of hemolysis and methemoglobinemia.     

血液透析联合血液灌流对尿毒症皮肤瘙痒效果分析

目的:分析血液透析联合血液灌流对于尿毒症患者皮肤瘙痒的治疗效果。方法:将36例患者随机分为观察组和对照组两组,各18例。对照组给予常规血液透析,观察组则应用血液透析联合血液灌流。观察两组患者皮肤瘙痒缓解的效果、患者血尿素氮(BUN)、血磷(P)、甲状旁腺素(PTH)的数值变化。结果:观察组总有效率高于对照组,两组比较差异有统计学意义(χ2=4.9846,P<0.05)。观察组治疗后BUN、P及PTH值与对照组治疗后比较,具有统计学意义(P<0.05)。两组患者治疗期间均未见明显不良反应。结论:血液透析联合血液灌流对尿毒症皮肤瘙痒的改善效果显著,值得临床推广应用。     

Polymyxin B-immobilized fiber column hemoperfusion removes endotoxin throughout a 24-hour treatment period

Purpose

The purpose of this study was to evaluate the extent of endotoxin adsorption by polymyxin B-immobilized fiber column hemoperfusion (PMX) performed for a 24-hour treatment period in patients with septic shock.

Materials and methods

Nineteen patients with septic shock were retrospectively studied. The plasma endotoxin concentrations of blood drawn from the radial artery and from the outlet circuit of the PMX column were measured by kinetic turbidimetric limulus assay using an MT-358 Toxinometer (Wako Pure Chemical Industries, Ltd, Osaka, Japan) after 24 hours of PMX treatment. The endotoxin removal rate was defined by the following equation: ([radial artery endotoxin concentration − outlet circuit of PMX column endotoxin concentration]/radial artery endotoxin concentration) × 100%.

Results

The patients had a median Acute Physiology and Chronic Health Evaluation II score of 29 at intensive care unit admission and a 28-day mortality of 47%. Before the start of the PMX treatment, the median radial arterial plasma endotoxin concentration was 16.48 pg/mL. After 24 hours of PMX treatment, the median radial plasma endotoxin concentration had decreased to 1.857 pg/mL, and the concentration at the outlet circuit of the PMX column was further decreased to 0.779 pg/mL. The median endotoxin removal rate was 74.4%.

Conclusion

These findings suggest that 24-hour PMX treatment was effective in removing endotoxin continuously throughout the entire treatment period.     

血液透析联合血液灌流治疗中血液灌流的时机选择

目的 探讨血液灌流(hemoperfusion,HP)的时机对血液透析(hemodialysis,HD)联合HP型组合型人工肾(combined artificial kidney,CAK)清除维持性血液透析(maintenance hemodialysis,MHD)患者尿毒症相关毒素效果的影响。方法 选取2012年7月至2013年1月于我院血透室接受HD治疗(4 h/次,3次/周)3个月以上的终末期肾病患者20例。所有患者先后接受2次不同方式的CAK治疗(A方式: HD第1、2小时同时行HP治疗; B方式: HD第3、4小时同时行HP治疗),两种方式随机交替进行,间隔2周。每次CAK治疗前、后留取血清标本,同批检测各种毒素水平,根据超滤量和透析前体质量校正透析后各毒素水平。用CAK治疗后各毒素下降绝对值和下降百分数评价不同CAK方式的清除效率。结果 (1)两种CAK治疗后各毒素水平均比治疗前降低,差异均有统计学意义(P<0.01); (2)两种方式CAK对小分子毒素肌酐(SCr)和尿素氮(BUN)的清除效果差异无统计学意义(P＞0.05); (3)B方式CAK对中分子毒素全段甲状旁腺激素(iPTH)与β₂-微球蛋白(β₂-MG)的清除效果更好,表现为更大的下降绝对值和下降百分数(P<0.05); (4)B方式CAK对炎症因子白介素1(IL-1)、白介素6(IL-6)和肿瘤坏死因子α(TNF-α)的清除效果更好,表现为更大的下降绝对值和(或)下降百分数(P<0.05); (5)两种方式CAK对炎症因子C反应蛋白(CRP)和五聚素3(PTX-3)的清除效果差异无统计学意义(P＞0.05); (6)两种方式CAK低血压、凝血等不良事件的发生率差异无统计学意义(P＞0.05)。结论 两种CAK方式对MHD患者的尿毒症相关毒素均有较好的清除效果。两者相比较,B方式CAK对 iPTH、β₂-MG、IL-1、IL-6和TNF-α的清除效果更好,且不增加不良事件发生率,有临床推广价值。     

大鼠颈内动脉恒速灌流测定脑血管阻力

经颈内动脉恒速灌流测量大白鼠脑血管阻力,其结果如下:收缩压为90.4±4.99mmHg,脑血管阻力为84.1±5.9mmHg。注射去甲肾上腺素后可使这些值增加,而酚妥拉明可使这些值降低。     

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。     

含氧血持续肺动脉灌注对体外循环后细胞因子水平的影响

目的探讨体外循环(cardiopulmonarybypass,CPB)期间含氧血持续肺动脉灌注对CPB术后细胞因子水平的影响。方法30例行二尖瓣置换术病人随机分成肺灌注组(15例)与对照组(15例)。肺灌注组病人CPB术中采用含氧血肺动脉持续灌注,对照组常规行二尖瓣置换术,未行肺动脉灌注。分别于术前、术后0h、6h抽取病人静脉血,采用双抗体夹心ABC-ELISA法测TNF-α、IL-8血浆浓度。结果同组术后较术前均明显升高(P<0.05);与对照组比较,肺灌注组术后0h、术后6hTNF-α与IL-8血浆浓度显著降低(P<0.05)。结论CPB心脏手术可引起术后细胞因子TNF-α、IL-8水平的升高,CPB术中含氧血持续肺动脉灌注可降低术后TNF-α、IL-8水平。     

血液灌流加长效托宁治疗重度有机磷中毒的效果观察

目的 :观察血液灌流加长效托宁治疗重度有机磷中毒 (HOPP)的疗效。方法 :按入院时间先后随机分成三组 ,对比观察治愈率、住院时间、用药次数及总药量。结果 :血液灌流并长效托宁组治愈率高 ,住院时间短 ,用药次数及总药量均明显减少。结论 :血液灌流并长效托宁可提高抢救成功率 ,降低医护人员的劳动强度 ,降低患者的医疗费用 ,可在临床推广应用