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目的 观察多种血液净化治疗技术在大面积毒鼠强中毒重危患者中的应用及其对毒鼠强的清除情况。方法 18例重症毒鼠强中毒患者入院后 ,除按常规治疗外 ,同时进行 3～ 5h的血液灌流 (HP)治疗 ,其后 15例患者继续进行连续性静 -静脉血液滤过 (CVVH) ,其中 2例还给予血浆透析治疗。测定HP后及CVVH治疗 2h、12h后患者血浆中毒鼠强下降的百分率。结果 使用 1个或 2个灌流器治疗 2h和 5h ,尽管清除量是增加的 ,但差异不显著。CVVH具备持续清除毒素的作用 ,在防止毒素反跳方面的作用除自然肾脏外尚无其他方式可以比拟。按患者的转归分为治愈组 (无后遗症 )和非治愈组 (死亡或呈现植物人状态、伴认知障碍 ) ,这 2组患者在年龄、昏迷抽搐及接受辅助呼吸人数方面没有差异 (P >0 .0 5 ) ,而在接受HP和CVVH治疗的开始时间方面差异有显著意义 (P <0 .0 5 )。结论 血液净化治疗能清除血浆中毒鼠强 ,明显改善患者预后 ,但须尽早进行。熟练掌握和实施血液净化各种技术的护理队伍及维持血液净化持续进行的各护理单位的协调合作是成功救治的关键
Objective To observe the application of multiple blood purification techniques in the treatment of severe poisoning rats and its elimination of tetramine poisoning. Methods 18 patients with severe tetramine poisoning admitted to hospital were treated with hemoperfusion (HP) for 3 ~ 5h except for routine treatment. Afterwards, 15 patients continued continuous venovenous hemofiltration (CVVH) Two of these patients also received plasma dialysis. Determination of HP and CVVH treatment 2h, 12h after plasma poisoning in patients with strong decline in the percentage. Results Treatment with 1 or 2 cartridges for 2 h and 5 h did not show significant differences although the clearance was increased. CVVH has the ability to continually clear toxins and has no other means of preventing toppling than natural kidneys. Patients were divided into treatment group (no sequelae) and non-cure group (death or vegetative state with cognitive impairment). There was no difference in age, coma and number of assisted resuscitation between the two groups (P> 0. 05), while there was a significant difference in the timing of initiation of HP and CVVH treatment (P <0.05). Conclusion Blood purification treatment can remove the poisoned rat plasma, significantly improve the prognosis of patients, but as soon as possible. The key to successful treatment is to master and implement the nursing team of various technologies for blood purification and to maintain the coordination and cooperation of the blood-purification continuous care units