血浆置换在急性白毒伞中毒性脑病治疗中的作用

目的探讨急性白毒伞中毒性脑病应用血浆置换的治疗机制。方法收集急性白毒伞中毒性脑病患者40例,随机将其分为血浆置换组及传统血液净化组,每组各20例。传统血液净化组患者采用传统血液灌流联合血液透析或血液滤过,血浆置换组行血浆置换,必要时联合血液滤过治疗。检测2组患者治疗前后血液、脑脊液中α-鹅膏毒肽的浓度,同期进行肝、肾功能等生化指标检测。结果经治疗后,血浆置换组患者血液、脑脊液中α-鹅膏毒肽浓度均显著下降(P均<0.01);传统血液净化组对α-鹅膏毒肽清除效果较差,治疗前后无明显差异(P>0.05)。2组患者治疗前后生化指标均有明显改善(P均<0.01);与传统血液净化组比较,血浆置换组患者肝功能改善更加明显(P<0.01)。结论血浆置换能有效清除血液中α-鹅膏毒肽,降低脑脊液中α-鹅膏毒肽浓度,减轻其对神经系统的损害,同时兼有人工肝脏替代治疗的作用,是急性白毒伞中毒的首选治疗措施。

Effect of plasma exchange in treatment of acute amanita verna poisoning encephalopathy

Objective It is to investigate the mechanism of plasma exchange in treatment of acute amanita verna poisoning encephalopathy.Methods 40 patients with acute amanita verna poisoning encephalopathy were randomly divided into plasma replacement group and traditional blood purification group,20 patients in each group.The patients in traditional blood purification group were treated by transfer of hemoperfusion combined with hemodialysis or hemofiltration;and in plasma replacement group,patients were treated by plasma exchange,if necessary,combined with hemofiltration therapy.The levels of α-amanita toxic peptides in blood and cerebrospinal fluid were detected before and after treatment in both groups,the functions of liver and renal were examined as well.Results After treatment,the levels of α-amanita toxic peptides in blood and cerebrospinal fluid of plasma replacement group were markedly decreased than before(all P<0.01);the removal effect for α-amanita toxic peptides in traditional blood purification group was not significant(P>0.05).The biochemical indices in both groups were improved obviously after treatment(all P<0.01);compared with traditional blood purification group,the function of liver and renal in plasma replacement group was improved as well(P<0.01).Conclusion Plasma exchange can effectively remove the level ofα-amanita toxic peptides in blood,reduce the concentration of α-amanita toxic peptides in cerebrospinal fluid,and reduce the neurological damage,is the first choice in treatment of acute amanita verna poisoning encephalopathy.