中国血液净化

›› 2006, Vol. 5 ›› Issue (1): 21-23.

• 论著 • 上一篇    下一篇

血液灌流联合二巯基丙醇救治急性毒鼠强中毒的临床研究

1郑大伟 1张在其 2黄泽亮 1彭 巍 1吴德华 1谢登荣 2杨华喜 1刘仁水 1李永亮 1邓顺莲
  

  1. 418400 怀化,1湖南省怀化市第二人民医院1 急诊科；2检验科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2006-01-12 发布日期:2006-01-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2006-01-12 Published:2006-01-12

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摘要：

目的　研究血液灌流(HP)联合二巯基丙醇救治急性毒鼠强中毒的临床疗效及患者血清β－内非肽(β-EP)，内皮素(ET),一氧化氮(NO),肿瘤坏死因子(TNF)在病程中的变化。方法 将湖南省怀化市第二人民医院急诊科1996年6月～2004年12月收治的56例患者分为A、B、C三组。①C组(常规+药物+HP）(n=20)与B组(常规+药物)(n=19)急性毒鼠强中毒39例患者，分别在入院后即刻、HP或入院后1、3、5、7、9、11d从外周静脉抽血2ml，测定β-EP、ET、NO与TNF。②A组（常规组）(n=17)为既往采用安定、苯巴比妥抗惊厥等一般救治措施；B组采用在A组治疗基础上加用二巯基丙醇治疗；C组在B组治疗基础上采用HP联合治疗。结果 ①C组和B组35例治愈者中，β-EP、ET、NO与TNF在C组均于入院后即刻达高峰，在B组均于入院后1d达高峰，随后均缓慢下降。C组和B组35例治愈者治疗后β-EP、ET、NO与TNF 对应指标比较，C组较B组均有显著性降低。②C组和B组患者治愈率比A组均有显著性提高。C组中的安定和苯巴比妥用量、止惊时间比B组、A组均有显著性减少；B组中的安定和苯巴比妥用量、止惊时间比A组均有显著性减少。结论 HP联合二巯基丙醇救治急性毒鼠强中毒临床疗效优于单纯二巯基丙醇和常规救治措施，可以明显降低患者β-EP、ET、NO与TNF水平，可作为治疗急性鼠毒强中毒的一种较为理想方案。

关键词: 毒鼠强, 中毒, 血液灌流, 二巯基丙醇, β－内非肽, 内皮素, 一氧化氮, 肿瘤坏死因子

Abstract: Objective To study the therapeutic efficacy of hemoperfusion(HP) and dimercaprol in rescuing patients with acute tetramine poisoning and dynamic variations of β-endorphin（β-EP），endothelins（ET），nitrogen monoxide（NO）and tumor necrosis factor（TNF）in serum Methods ①Thirty-nine patients with acute tetramine poisoning (group C and B group）were enrolled in this study．Theirβ-EP，ET，NO and TNF were measured upon hospitalization and 1d、3d、5d、7d、9d、11d after hospitalization respectively．②They all received routine therapy, such as diazepam, phenobarbital sodium etc patients in group C and group B rereived dimercaprol. Hemoperfusion was applied in group C.Group A received routine therapy only. Results ①The levels of β-EP，ET，NO and TNF from 35 patients who were cured peaked at hospitalization in group C, and 1d after hospitalization in group B，then decreased gradually．The levels of β-EP，ET，NO and TNF after rescuing in C group were significantly less than those of group B. ②The efficiency in group C and group B were significantly higher than in group A,the accumulative amount of diazepam and phenobarbital，the eclampsia duration in group C were significantly less than those of group A and B,and group B were significantly less than those of group A. Conclusion The therapeutic efficacy of hemoperfusion and dimercaprol in rescuing patients with acute tetramine poisoning is better than dimercaprol and routine therapy only. It decrease levels of β-EP，ET，NO and TNF significantly，and can be considered as a better therapeutic method on treating tetramine poisoning.

Key words: Poisoning, Hemoperfusion, Dimercaprol, β-endorphin, Endothelins, Nitrogen monoxide, Tumor necrosis factor

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