中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (09): 583-587.doi: 10.3969/j.issn.1671-4091.2018.09.002

• 临床研究 • 上一篇    下一篇

不同血液净化方式对砷化氢中毒肾脏损伤预后的影响

谢曼丽1,杜永峰1,蒋红利2   

  1. 1.西安市中中心医院职业病科 2.西安交通大学第一附属医院血液净化科
  • 收稿日期:2018-04-10 修回日期:2018-06-20 出版日期:2018-09-12 发布日期:2018-08-24
  • 通讯作者: 蒋红利 570016744@qq.com E-mail:xmlxazx@163.com

Effects of different blood purification modalities on prognosis of renal damage induced by arsine poisoning

  • Received:2018-04-10 Revised:2018-06-20 Online:2018-09-12 Published:2018-08-24

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摘要： 【摘要】目的探讨连续性静脉-静脉血液滤过(continuous venous-venous blood filtration，CVVH)与血液透析(hematodialysis，HD)配合血液灌流(blood perfusion，HP) 在砷化氢中毒患者中的应用效果及对肾脏损伤预后的影响。方法将入院接受治疗的40 例砷中毒患者均分为2 组，对照组在常规治疗基础上采用HD+HP 进行血液净化治疗；观察组则选择CVVH+HP 进行治疗。记录2 组临床症状消退、血液净化及住院时间；对比入院时及治疗后2 组溶血指标及肾功能指标变化；测定2 组入院及治疗3d 透析液及尿砷含量。结果与对照组比，观察组平均血液净化时间(t=13.836，P=0.003)、血红蛋白尿(t=7.381，P=0.041)、发热畏寒(t=9.029，P=0.034)、黄疸(t=7.903，P=0.039)、乏力腰背痛(t=9.623，P=0.022)等临床症状消退及住院时间(t=18.349，P=0.001)均明显缩短。治疗1d 血清血红蛋白(hemoglobin，Hb)含量下降，第3d 开始回升；血清总胆红质(total bilirubine tbil，TBIL)在治疗后持续下降，血肌酐(serum creatinine，Scr)、尿素氮(urea nitrogen，BUN)第1d 明显升高，之后持续下降。方差分析显示，上述4 项检测指标在入院时及治疗后4 个时间点的差异具有显著意义(Hb：F=18.591，P=0.006；
TBIL：F = 71.855, P ＜ 0.001；Scr：F = 154.622, P = ＜0.001；BUN：F = 17.728, P = 0.011)。治疗后4 个时间点血清TBIL ( 对照组 t = 7.664、6.722、6.330、12.684, P=0.017、0.021、0.024、0.006；观察组t=8.338、12.564、14.629、7.188, P=0.014、0.006、0.005、0.019)、Hb( 对照组t=4.382、4.168、4.496、- 4.779, P=0.048、0.044、0.047、0.041；观察组 t = 6.416、4.512、4.408、5.081, P = 0.023、0.046、0.049、0.041)、Scr ( 对照组t=- 11.680、- 12.665、- 5.768、- 9.846，P=0.007、0.006、0.033、0.010；观察组t=- 8.526、- 12.814、-10.596、17.928，P=0.013、0.006、0.009、0.003)、BUN(对照组t=-4.575、-4.509、4.826、6.646，P=0.045、0.046、0.042、0.031；观察组t=-4.552、5.778、6.269、6.744，P=0.046、0.043、0.040、0.032)水平与入院
时比差异均存在显著意义，且治疗后观察组各时间点血清TBIL(t=10.757、19.228、3.869、6.509，P=0.009、0.003、0.023、0.018)、Hb(t=4.375、3.828、6.032、5.966，P=0.043、0.048、0.037、0.038)、Scr(t=4.792、7.105、5.811、6.225，P=0.041、0.033、0.037、0.035)、BUN(t=4.492、6.113、5.708、7.116，P=0.048、0.041、0.043、0.039)水平均明显优于对照组。治疗7d 时，2 组透析液及尿液中砷含量均下降到正常水平，且观察组砷含量均明显低于对照组(透析液F=12.234，P=0.005；尿液：F=10.856，P=0.011)。结论砷中毒患者早期采用CVVH+HP 进行血液净化治疗，可快速清除砷及其复合物、缩短病程、缓解其对肾脏的损伤，有效改善患者预后。

关键词: 砷化氢中毒/血液净化, 血流灌注, 连续性静脉-静脉血液滤过, 血液透析, 肾损伤

Abstract: 【Abstract】Objective To investigate the effects of continuous venous-venous hemofiltration (CVVH) and hemodialysis (HD) combined with hemoperfusion (HP) on the prognosis of renal injury in patients with arsine poisoning. Methods A total of 40 patients with arsine poisoning treated in the hospital were divided into two groups: control group treated with HD+HP and observation group treated with CVVH+HP in addition to routine management. The duration of clinical symptoms, blood purification and hospitalization were record. The changes of hemolysis and renal function indices, and the arsine content in dialysate and urine at the time of admission and after the treatment were compared between the two groups. Results The average duration of blood purification (t=13.836, P=0.003), hemoglobinuria (t=7.381, P=0.041), fever and chills (t=9.029, P=0.034), jaundice (t=7.903, P=0.039), fatigue, back pain and other clinical symptoms (t=9.623, P=0.022) and hospitalization (t=18.349, P=0.001) were significantly shortened in observation group as compared with those in control group. Serum Hb content decreased after the treatment for one day, and began to rise after the treatment for 3 days. Serum total bilirubin (TBIL) decreased continuously after the treatment. Serum creatinine (Scr) and BUN increased at the first treatment day and then decreased continuously. Analysis of variance showed that the values of serum HB, TBIL, Scr and BUN at the admission were significantly different from those at the 4 time points after the treatment (F=18.591, P=0.006 for serum HB; F=71.855, P<0.001 for serum TBIL; F=154.622, P<0.001 for Scr; F=17.728, P=0.011 for BUN). At the 4 time points after the treatment, the values of serum TBIL, serum HB, Scr and BUN in both control group and observation group were significantly different as compared with those at the admission (for serum TBIL: t=7.664, 6.722, 6.330 and 12.684, P= 0.017, 0.021, 0.024 and 0.006 in control group; t=8.338, 12.564, 14.629 and 7.188, P=0.014, 0.006, 0.005 and 0.019 in observation group; for serum Hb: t=4.382, 4.168, 4.496 and -4.779, P=0.048, 0.044, 0.047 and 0.041
in control group; t=6.416, 4.512, 4.408 and 5.081, P=0.023, 0.046, 0.049 and 0.041 in observation group; for Scr: t=- 11.680, - 12.665, - 5.768 and - 9.846, P=0.007, 0.006, 0.033 and 0.010 in control group; t=- 8.526, -12.814, - 10.596 and 17.928, P=0.013, 0.006, 0.009 and 0.003 in observation group; for BUN: t=- 4.575, -4.509, 4.826 and 6.646, P=0.045, 0.046, 0.04 and 0.031 in control group; t=-4.552, 5.778, 6.269 and 6.744, P=0.046, 0.043, 0.040 and 0.032 in observation group). Furthermore, the values of serum TBIL, serum HB, Scr and BUN at the 4 time points were clinically better in observation group than in control group (for TBIL: t=10.757, 19.228, 3.869 and 6.509, P=0.009, 0.003, 0.023 and 0.018; for serum HB: t=4.375, 3.828, 6.032 and 5.966, P=0.043, 0.048, 0.037 and 0.038; for Scr: t=4.792, 7.105, 5.811 and 6.225, P=0.041, 0.033, 0.037 and 0.035; for BUN: t=4.492, 6.113, 5.708 and 7.116, P=0.048, 0.041, 0.043 and 0.039). After the treatment for 7 days, arsine content in dialysate and urine decreased to normal levels, and were lower in observation group than in control group (arsine in dialysate: F=12.234, P=0.005; arsine in urine: F=10.856, P=0.011). Conclusion The early use of CVVH+HP for blood purification in arsine poisoning patients can quickly remove arsine and its related compounds, shorten the disease course, relieve kidney damage, and improve prognosis of the patients.

Key words: Arsenic poisoning, Blood purification, Blood perfusion, Continuous veno-venous hemofiltration, Hemodialysis, Kidney injury