血液净化治疗急性中毒患者的心功能监护

目的了解接受血液净化治疗的急性中毒患者心肌损害及循环功能改变情况,探讨保障血液净化治疗安全的应对措施。方法分析广州市第十二人民医院2000年1月～2004年5月的47例急性中毒患者在105次血液净化治疗阶段的心肌酶谱和心电图检查结果,发生急性并发症的情况等,总结心功能损害对血液净化治疗安全性的影响。结果本组病例80.9%存在心功能损害情况,68.1%在中毒后24～48h内出现心肌酶指标改变,接受血液净化治疗期间心电图检查异常63次(60%),心肌酶谱异常115次(71.0%);23例(48.9%)发生急性并发症,共40次(38.1%),其中血压降低18次(45%),升高1次(2.5%),心律不齐5次(12.5%),呼吸困难2次(5.0%),过敏反应6次(15.0%),出血、溶血4次(10.0%),躁动4次(10.0%),与其他疾病行血液净化治疗患者相比,发生次数多、情况复杂且程度严重,有非常显著的统计学意义(χ2=16.1,P=6E-05)。结论中毒患者存在较严重的心功能损害,接受血液净化治疗中应严密监测循环指标和心功能指标,控制各环节平稳转流,转流前后加强支持疗法,提高患者机体承受能力,保证治疗安全。

Monitoring cardiac function in the course of blood purification for treating the acute poisoning patients

Objective To observe the countermeasure for the blood purification in the security treatment of acute intoxication with myocardial damage and circulatory system injury. Methods To analysis 47 poisoning patients 105 cases ECG and myocardium enzyme-grams and electrocardiograph data as well as other acute complication, try to find the influence factors of myocardial damage in the course of blood purification treatment. Result 80. 9% of the all the cases contain cardiac damage 68.1% patients bold the abnormal myocardium enzyme index 24-48 hours after acute intoxication. There were 63 cases ECG abnormal, 115cases myocardium enzyme-grams unusual, 23 examples acute complications, totals 40 cases,5 cases arrhythmia, 2 cases dyspnoea, 6 cases allergy, 4 cases bleeding or haemolysis and 4 cases restlessness during the blood purification. The complications in acute poisoning patients were more serious and more complex compare with the other diseases. Conclusion Most of acute poisoning patients accompanied more serious cardiac damage. Strict custody for myocardial and circulatory function should be taken in blood purification, and strengthen supporting therapeutics were necessary for the security treatment of blood purification.