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目的应用血浆置换、血液滤过、血液透析等不同血液净化方法联合治疗毒蛇咬伤中毒,探索一种有效的治疗毒蛇咬伤中毒伴多脏器衰竭的临床治疗方法。方法在内科常规抗蛇毒血清治疗仍出现病情进行性恶化的情况下,应用血液净化疗法:血浆置换联合连续性血液滤过治疗,以4%的白蛋白溶液做置换液,置换量3升,血浆置换后继续转入连续性血液滤过(CRRT),置换量为4L/h,持续CRRT治疗72小时后生命体征基本稳定,临床症状以急性肾功能衰竭伴少尿为主,遂转入规律性血液透析,每周三次,直至治愈出院。结果与结论患者经血浆置换联合血液滤过治疗72小时后生命体征稳定,复查各项化验结果(包括DIC系列)正常,但血肌酐、尿素氮升高,尿量24小时不足100ml,改用血液透析方法治疗,一月后尿量恢复正常,血肌酐、尿素氮化验结果正常。
Objective To apply the method of plasma exchange, hemofiltration and hemodialysis to treat poisonous snake bites and to explore an effective treatment for poisonous snake bites with multiple organ failure. Methods In the condition of medical treatment with conventional anti-snake venom serum, the blood purification therapy was used: plasma exchange combined with continuous hemofiltration, 4% albumin solution, displacement volume 3 liters, plasma Continuation of continuous replacement after the replacement of hemofiltration (CRRT), the replacement volume of 4L / h, continuous vital signs of CRRT 72 hours after treatment basically stable, clinical symptoms of acute renal failure with oliguria, then transferred to the regular Hemodialysis three times a week until cured. RESULTS AND CONCLUSION: The vital signs were stable after 72 hours of plasma exchange and hemodiafiltration. All the results of the review (including DIC series) were normal. However, serum creatinine and urea nitrogen increased, and urine output was less than 100ml in 24 hours and switched to blood Dialysis treatment, urine output returned to normal after January, serum creatinine, urea nitrogen test results were normal.