Keusch G
Departement Innere Medizin, Universitätsspital Zürich.
Ther Umsch. 1992 Feb;49(2):113-7.
Invasive methods of active removal, i.e., hemodialysis and hemoperfusion, are indicated for severely poisoned patients with substances causing tissue damage. Both methods will only be efficacious if the relative contribution of the extracorporal clearance to the overall elimination for a given substance is high and if the toxin has a relatively low apparent volume of distribution and a low tissue binding. Hemodialysis is recommended in severe life threatening intoxications with methanol, ethylene glycol, isopropyl alcohol, salicylates and lithium. Hemoperfusion is effective in removing theophylline and barbiturates. Patients with severe acute theophylline intoxication will benefit from hemoperfusion. Despite the very high clearance rates of barbiturates that can be obtained with hemoperfusion, the clinical usefulness of hemoperfusion remains to be proven.
主动清除的侵入性方法，即血液透析和血液灌流，适用于因导致组织损伤的物质而严重中毒的患者。只有当体外清除对给定物质的总体清除的相对贡献较高，且毒素的表观分布容积相对较低且组织结合力较低时，这两种方法才会有效。对于甲醇、乙二醇、异丙醇、水杨酸盐和锂严重危及生命的中毒，建议进行血液透析。血液灌流对清除茶碱和巴比妥类药物有效。严重急性茶碱中毒的患者将从血液灌流中获益。尽管血液灌流可获得非常高的巴比妥类药物清除率，但其临床实用性仍有待证实。
