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目的探讨血浆置换(PE)对蓖麻子中毒儿童的治疗效果。方法7例蓖麻子中毒儿童,在常规治疗的基础上,于误食生蓖麻子后30~91 h给予PE治疗,观察PE治疗前后临床症状及生命体征变化,比较PE治疗前后血常规、血生化和血气分析。结果 PE治疗后患儿的临床症状和体征迅速恢复正常,所有患儿均痊愈出院,未遗留任何系统器官功能障碍和后遗症;PE治疗后血清碱性磷酸酶(AKP)、肌酸磷酸激酶(CK)、a-羟丁酸脱氢酶(HBD)、胆碱酯酶(CLA)明显低于PE治疗前(P<0.05或P<0.01),心肌型肌酸激酶同功酶(CK-MB)和乳酸脱氢酶(LDH)有下降趋势,但无统计学意义(P>0.05);PE治疗后外周血白细胞(WBC)、中性粒细胞(N)和血小板(PLT)计数有下降趋势,淋巴细胞(L)和红细胞(RBC)计数有上升趋势,但均无统计学意义(P>0.05),血红蛋白(Hb)较PE治疗前明显升高(P<0.05);PE治疗后pH值、碳酸氢根(HCO_3~-)和剩余碱(BE)明显高于PE治疗前(P<0.01),阴离子间隙(AG)明显低于PE治疗前(P<0.01)。结论对于病情较重的蓖麻子中毒儿童,在常规治疗的基础上有条件可早期行PE治疗,以彻底清除已进入血液和组织器官的毒素,减少后续损伤,确保患儿生命安全。
Objective To investigate the therapeutic effect of plasma exchange (PE) on children with castor bean poisoning. Methods Seven children with castor seed poisoning were treated with PE on the basis of routine treatment 30 to 91 h after inoculation with castor oil. The clinical symptoms and signs of vital signs were observed before and after PE treatment. The blood and blood biochemistry before and after PE treatment were compared. And blood gas analysis. Results After PE treatment, the clinical symptoms and signs of the children returned to normal quickly, and all the patients were cured and discharged without any systemic organ dysfunction and sequelae. The levels of serum alkaline phosphatase (AKP), creatine phosphokinase (CK) ), A-hydroxybutyrate dehydrogenase (HBD) and cholinesterase (CLA) were significantly lower than those before PE treatment (P <0.05 or P <0.01) And lactate dehydrogenase (LDH), but there was no statistical significance (P> 0.05). The counts of peripheral blood leukocytes (WBC), neutrophils (N) and platelets (PLT) The counts of lymphocytes (L) and erythrocytes (RBC) showed an upward trend, but there was no statistical significance (P> 0.05). Hb was significantly higher than that before PE (P <0.05) The bicarbonate (HCO 3 -) and residual base (BE) were significantly higher than those before PE treatment (P <0.01), and the anion gap (AG) was significantly lower than before PE treatment (P <0.01). Conclusion For castrate poisoning children with severe illness, on the basis of routine treatment, PE can be treated early to eliminate the toxins that have entered the blood and tissues and organs, reduce the subsequent injury, and ensure the safety of children.