Dehua Gong, Daxi Ji, Honglang Xie, Bin Xu, Yun Liu, Leishi Li
Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China.
Blood Purif. 2006;24(5-6):524-30. doi: 10.1159/000096473. Epub 2006 Oct 23.
It was the aim of this study to observe the effects of sequential hemoperfusion (HP) and continuous venovenous hemofiltration (CVVH) on patients with severe tetramine poisoning and to evaluate the ability of these modalities to remove tetramine.
Eighteen patients diagnosed as having severe tetramine poisoning were treated by blood purification, additional to routine medical therapy. Blood purification procedures included HP using activated charcoal for 3-5 h and consecutive CVVH for 24-36 h. Patients' clinical conditions, blood routine tests and serum chemical tests were evaluated every day after admission. Plasma tetramine concentrations were determined before and after HP. During CVVH, tetramine concentrations in plasma before and after passing through the filter and ultrafiltration at 2 and 12 h were also determined.
Eight patients received blood purification within 12 h after onset of poisoning, and 10 patients received blood purification more than 12 h later. Early-treated patients showed a higher cure rate (100 vs. 60.0%; p < 0.05, chi(2) test) and shorter coma time than late-treated patients (26.0 +/- 23.2 h, range 5-70, vs. 59.7 +/- 27.7 h, range 20-96; p < 0.01, rank test). The mean plasma tetramine concentrations in early- and late-treated patients were comparable (0.095 +/- 0.036 vs. 0.134 +/- 0.110 mg/l; p > 0.05). Mean plasma tetramine concentration was reduced from 0.124 +/- 0.082 to 0.080 +/- 0.055 mg/l after HP. At 2 h of CVVH, mean plasma tetramine concentration was 0.078 +/- 0.064 mg/l, at 12 h of CVVH, 0.074 +/- 0.059 mg/l, and the ultrafiltration sieving coefficient at 2 and 12 h was 0.839 +/- 0.409 and 0.686 +/- 0.253 mg/l, respectively.
Early sequential HP and CVVH therapy may significantly improve the outcome of patients with severe tetramine intoxication. HP can rapidly reduce the plasma concentration of tetramine, and CVVH can attenuate the plasma tetramine concentration rebound after HP by continuously removing tetramine from the plasma.
本研究旨在观察序贯血液灌流（HP）和连续性静脉-静脉血液滤过（CVVH）对重度毒鼠强中毒患者的影响，并评估这些治疗方式清除毒鼠强的能力。
18例诊断为重度毒鼠强中毒的患者在常规药物治疗基础上接受血液净化治疗。血液净化程序包括使用活性炭进行HP 3 - 5小时，随后连续进行CVVH 24 - 36小时。入院后每天评估患者的临床状况、血常规检查和血清化学检查。在HP治疗前后测定血浆毒鼠强浓度。在CVVH过程中，还测定了血液通过滤器前后及2小时和12小时超滤时的血浆毒鼠强浓度。
8例患者在中毒后12小时内接受血液净化治疗，10例患者在12小时后接受血液净化治疗。早期治疗的患者治愈率较高（100%对60.0%；p < 0.05，卡方检验），昏迷时间比晚期治疗的患者短（26.0±23.2小时，范围5 - 70小时，对59.7±27.7小时，范围20 - 96小时；p < 0.01，秩和检验）。早期和晚期治疗患者的血浆毒鼠强平均浓度相当（0.095±0.036对0.134±0.110mg/L；p > 0.05）。HP治疗后血浆毒鼠强平均浓度从0.124±0.082降至0.080±0.055mg/L。在CVVH 2小时时，血浆毒鼠强平均浓度为0.078±0.064mg/L，在CVVH 12小时时为0.074±0.059mg/L，2小时和12小时的超滤筛系数分别为0.839±0.409和0.686±0.253mg/L。
早期序贯HP和CVVH治疗可显著改善重度毒鼠强中毒患者的预后。HP可迅速降低血浆毒鼠强浓度，CVVH可通过持续从血浆中清除毒鼠强来减轻HP后血浆毒鼠强浓度的反弹。
