Nenov Vesselin D, Marinov Petko, Sabeva Julia, Nenov Dimitar S
Renal Division, Medical University of Varna and. Clinic of Toxicology, Military Hospital of Varna, Bulgaria.
Nephrol Dial Transplant. 2003 Jul;18 Suppl 5:v56-8. doi: 10.1093/ndt/gfg1049.
The clinical applications of plasmapheresis are rapidly increasing in number and scope. This trend is also observed in the application of plasmapheresis as a method of detoxification in clinical toxicology. Because of a lack of large controlled series, the rationale for using plasmapheresis must be confirmed in each type of intoxication by evidence of effective clearance, as well as by high plasma protein binding and a low volume of distribution of the toxic substance. Plasmapheresis is used mostly to treat phalloid mushroom intoxications. In this potentially fatal intoxication, for which there is no antidote, plasmapheresis is at least as effective as haemoperfusion in reducing mortality from as high as 30-50% with conventional therapy to <20%. In our series of 28 patients treated with plasmapheresis, mortality was 17.8%. In our experience, plasmaphe-resis is also very effective in the treatment of life-threatening intoxications with tricyclic (amitriptyline) and 4-cyclic (maprotyline) antidepressants. We confirmed a 63% reduction in the plasma level of amitriptyline in one patient after single plasmapheresis. Other drugs such as L-thyroxine, verapamil, diltiazem and carbamazepime are also removed effectively by plasmapheresis, as are theophylline and heavy metals (mercury and vanadate). Phosphoroorganic substances are not removed effectively. We measured the plasma concentrations of dimethoate in two patients with this intoxication and did not find clinically significant clearance with plasmapheresis.
血浆置换的临床应用在数量和范围上都在迅速增加。在临床毒理学中将血浆置换作为一种解毒方法的应用中也观察到了这一趋势。由于缺乏大量对照研究系列，使用血浆置换的理论依据必须在每种中毒类型中通过有效清除的证据以及高血浆蛋白结合率和低毒物分布容积来证实。血浆置换主要用于治疗毒伞蕈中毒。在这种潜在致命的中毒中，由于没有解毒剂，血浆置换在降低死亡率方面至少与血液灌流一样有效，可将传统治疗高达30 - 50%的死亡率降至<20%。在我们用血浆置换治疗的28例患者系列中，死亡率为17.8%。根据我们的经验，血浆置换在治疗三环类（阿米替林）和四环类（马普替林）抗抑郁药引起的危及生命的中毒方面也非常有效。我们证实一名患者单次血浆置换后阿米替林血浆水平降低了63%。其他药物如左甲状腺素、维拉帕米、地尔硫卓和卡马西平也能通过血浆置换有效清除，茶碱和重金属（汞和钒酸盐）也是如此。有机磷物质不能被有效清除。我们测量了两名该中毒患者的乐果血浆浓度，未发现血浆置换有临床显著的清除效果。
