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目的 研究鱼胆中毒后肝、肾、心肌及胃肠道功能的变化 ,探讨其导致急性肾功能衰竭的发病机制 ,并总结治疗鱼胆中毒的成功经验。方法 1997年 9月至 1999年 10月期间 ,我院急诊科收治了 11例鱼胆中毒患者。我们对其治疗前后及出院时肝、肾功能、心肌酶学、尿N 乙酰 β D 氨基葡萄糖苷酶 (N AG)进行了观察 ;1例患者在B超下行肾活检 ,观察其肾脏病理变化。结果 11例患者全部发生多脏器功能障碍综合征 (MODS) ,其中急性肾功能衰竭 11例 ,肝功能损害 10例 ,中毒性心肌炎 10例及胃肠道功能障碍 8例 ,中毒后多脏器受损程度依次为肾、肝、心肌及胃肠道。治疗后肝、肾功能、心肌酶学、尿N AG酶较治疗前明显改善 (P <0 0 5 )。肾穿刺检查显示肾小管中毒性损害 (主要为近曲小管 )。 11例患者全部康复出院。结论 鱼胆中毒可引起多脏器功能障碍综合征 ,按照受损程度依次为肾、肝、心肌及胃肠道。鱼胆中毒致急性肾功能衰竭的发病机制是近曲肾小管的严重损害 ,这是首次经肾活检证实的。我们认为尽早进行血液透析是最有效的治疗方法。
Objective To study the changes of liver, kidney, myocardium and gastrointestinal tract after fish gall bladder poisoning, and to explore the pathogenesis of acute renal failure and to summarize the successful experience in the treatment of fish gall poisoning. Methods From September 1997 to October 1999, 11 cases of fish poisoning were admitted to the emergency department of our hospital. We observed the liver, kidney function, myocardial enzyme, urine N-acetylglucosaminidase (NAG) before and after treatment and at hospital discharge. One patient underwent renal biopsy at B-ultrasound, and the pathological changes of kidney were observed. Results All 11 patients developed multiple organ dysfunction syndrome (MODS), including 11 cases of acute renal failure, 10 cases of hepatic dysfunction, 10 cases of toxic myocarditis and 8 cases of gastrointestinal dysfunction. The order of damage was kidney, liver, myocardium and gastrointestinal tract. After treatment, liver, kidney function, myocardial enzymology and urine NAG enzyme were significantly improved (P <0.05). Renal puncture examination showed toxic renal tubular damage (mainly proximal tubule). All 11 patients were discharged from hospital. Conclusion Fish gall bladder poisoning can cause multiple organ dysfunction syndrome, according to the degree of damage were kidney, liver, myocardium and gastrointestinal tract. Fish gallbladder poisoning caused by acute renal failure pathogenesis of proximal tubule serious damage, this is the first confirmed by renal biopsy. We believe that the earliest hemodialysis is the most effective treatment.