CVVHDF联合活性炭血液灌流器治疗鱼胆中毒致多脏器功能障碍综合症一例

doi:10.3969/j.issn.1004-583X.2022.08.012

摘要/Abstract

摘要：

目的观察连续性静静脉血液透析滤过(CVVHDF)联合活性炭血液灌流治疗鱼胆中毒致多脏器功能障碍综合症(MODS)的疗效。方法对该患者进行CVVHDF联合活性炭治疗,并观察治疗后患者肝功能、心功能、凝血功能等指标的变化趋势及其疗效。结果经3次活性炭及3次CVVHDF治疗后,患者出院时肝功能、肾功能、心功能、凝血功能等指标均恢复正常或大致恢复正常。结论在其他综合治疗的基础上,应用CVVHDF联合活性炭血液灌流可以改善鱼胆中毒致MODS患者的组织器官的灌注和血液生化指标,明显改善预后及疾病转归。

关键词: 多器官功能衰竭, 鱼胆中毒, 血液灌流(活性炭), 血液透析

Abstract:

Objective To observe the effect of continuous veno-venous hemodiafiltration (CVVHDF) plus activated charcoal hemoperfusion in treatment of multiple organ dysfunction syndrome (MODS) caused by bile poisoning. Methods The patient was treated with CVVHDF combined with HP (activated charcoal),and the trend of liver function, kidney function, cardiac function, coagulation function and other indicators as well as its efficacy after the treatment were observed. Results After 3 HP (activated charcoal) and 3 CVVHDF treatments, the liver function, kidney function, cardiac function, coagulation function and other indicators of this patient returned to normal when discharged. Conclusion On the basis of comprehensive treatment, CVVHDF plus activated charcoal hemoperfusion and other comprehensive treatment can improve the patients'perfusion of tissues and organs and blood biochemical indicators, as well as the patients' prognosis and disease outcome.

Key words: multiple organ failure, fish bile poisoning, hemoperfusion (activated charcoal), hemodialysis

中图分类号:

R365

刘佩华, 杨倩, 刘志强, 梁璐. CVVHDF联合活性炭血液灌流器治疗鱼胆中毒致多脏器功能障碍综合症一例[J]. 临床荟萃, 2022, 37(8): 738-742.

Liu Peihua, Yang Qian, Liu Zhiqiang, Liang Lu. Continuous veno-venous hemodiafiltration plus activated charcoal hemoperfusion in treatment of multiple organ dysfunction syndrome caused by fish bile poisoning: one case[J]. Clinical Focus, 2022, 37(8): 738-742.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.08.012

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I8/738

图/表 6

参考文献 24

[1]	吴华, 胡岗, 付华, 程源松, 文放桃. 对黔东南少数民族地区鱼胆中毒患者进行血液透析治疗的效果探讨[J]. 当代医药论述, 2018, 16(17):94-95.
[2]	李晴晴, 崔雯. 鱼胆致急性肾损伤病例1例及鱼胆中毒的健康宣教[J]. 饮食保健, 2018, 5(18):267.
[3]	张敏, 李倩. 急性鱼胆中毒致急性肝肾功能损害1例报道[J]. 锦州医科大学学报, 2018, 39(3):111-112.
[4]	Park SK, Kim DG, Kang SK, et al. Toxic acute renal failure and hepatitis after ingestion of raw carp bile[J]. Nephron, 1990, 56(2):188-193. pmid: 2243575
[5]	Pandey NR, Yu Yao B, Khakurel S. Acute renal failure after consumption of fish gall bladder[J]. Case Rep Emerg Med, 2014: 194129.
[6]	Krishna A, Singh PP. Acute kidney injury with consumption of raw gall bladder of Indian carp fish (Labeo rohita): A single center study from India[J]. Nephrology (Carlton), 2019, 24(1):47-49. doi: 10.1111/nep.13199 URL
[7]	李时珍. 本草纲目[M]. 北京: 人民卫生出版社, 2004.
[8]	胡祥仁, 陆林, 王云生, 等. 急性鱼胆中毒86例临床分析[J]. 中华内科杂志, 2000, 39(4):273-274.
[9]	史欢. 7例儿童急性鱼胆中毒的护理体会[J]. 健康必读, 2018, 20:114.
[10]	湛丽莎, 杨国辉. 急性鱼胆中毒致急性心肝肾功能损害1例[J]. 临床急诊杂志, 2019, 20(11):905-907.
[11]	杨霄, 鲁成. 血液灌流联合血液透析应用治疗口服鱼胆急性中毒患[J]. 饮食保健, 2018, 6(50):66-67.
[12]	Yan W, Wang Z, Lu S, et al. Analysis of factors related to prognosis and death of fish bile poisoning in China: A retrospective study[J]. Basic Clin Pharmacol Toxicol, 2020, 127(5):419-428. doi: 10.1111/bcpt.13447 URL
[13]	孙静, 宋玟林, 梁劲松, 等. 血液净化治疗急性鱼胆中毒导致多器官功能衰竭报道1例-贵州省医学会肾脏病学分会暨血液净化分会学术年会论文集[C]. 贵阳: 医药卫生科技出版社, 2018:168-170.
[14]	马乐通, 吕培生, 张伟, 等. 血液灌流治疗鱼胆中毒一例[J]. 职业卫生与应急救援, 2017, 35(3):289-290.
[15]	邓隆银, 廖华伟, 涂丽荣. 鱼胆中毒引起心脏损害的临床分析[J]. 川北医学院学报, 2000, 15(1):23-24.
[16]	郝爱华, 罗蓉, 刘震. 鱼胆中毒15例临床分析[J]. 临床儿科杂志, 1997, 15(3):188.
[17]	汪文洋, 陈叶, 童姝睿, 等. 草鱼胆中毒致严重肝损伤为主的多器官损伤救护体会[J]. 肝脏, 2022, 27(1):106-108.
[18]	曾贵峰, 雷讯文, 王俭勤. 鱼胆中毒治疗的研究进展[J]. 中国保健营养(临床医学学刊), 2008, 17 (4):177-178.
[19]	顾旭东, 孙海晨, 聂时南, 等. 鱼胆中毒并发多脏器功能障碍综合征的临床分析[J]. 中国急救医学, 2009, 29(7):634-636.
[20]	邹建华, 王月芳. 血液透析治疗鱼胆中毒致急性肾功能衰竭患者的临床效果观察[J]. 临床合理用药, 2015, 8(1):9-10.
[21]	马盼盼. 鱼胆中毒致脏器损伤37例临床分析[D]. 长春: 吉林大学, 2017.
[22]	马盼盼, 姜晓明, 韩东锋, 等. 连续性静脉-静脉血液透析滤过联合血液灌流成功救治大量鱼胆中毒致肝衰竭1例报告[J]. 临床肝胆病杂志, 2016, 32(12):2367-2368.
[23]	张明浩, 张伟, 简伟明, 等. 血液灌流治疗急性重度有机磷农药中毒安全性和有效性的Meta分析[J]. 医学综述, 2020, 26(14):2866-2873.
[24]	陈光明, 陈秀丽, 王承峰, 等. 血浆置换治疗以肝脏损害为突出表现的儿童鱼胆中毒[J]. 中国急救复苏与灾害医学杂志, 2016, 11(4):373-376.

项目	正常范围	1 d	2 d	3 d	4 d	5 d	6 d
CKMB(ng/ml)	0~2.03	37.5	20.6	9.29	9.7	6.24	1.42
Myo(ng/ml)	0~61.5	537.2	698.1	364.4	215.3	101.5	85.4
CTnI(ng/ml)	0~0.034	0.630	0.424	0.258	0.126	0.096	0.059
NTproBNP(pg/ml)	0~125	>35000	22900	21000	9500	9000	8650

项目	正常范围	1 d	2 d	3 d	4 d	5 d	6 d
CKMB(ng/ml)	0~2.03	37.5	20.6	9.29	9.7	6.24	1.42
Myo(ng/ml)	0~61.5	537.2	698.1	364.4	215.3	101.5	85.4
CTnI(ng/ml)	0~0.034	0.630	0.424	0.258	0.126	0.096	0.059
NTproBNP(pg/ml)	0~125	>35000	22900	21000	9500	9000	8650

项目	正常范围	1 d	2 d	3 d	4 d	5 d	6 d
AST(U/L)	13~35	46	33	30	27	28	25
ALT(U/L)	7~40	268	178	176	130	91	54
TBI(μmol/L)	3.0~21.0	62.7	70.2	55.9	40.9	35.6	23.2
DBI(μmol/L)	0.0~7.0	44.6	49.8	39.2	27.7	22.9	15.3
IBIL(μmol/L)	3.0~14.0	18.1	20.4	16.7	13.2	12.7	7.9
CHE(U/L)	4000~13000	3598	3027	3491	3706	4047	4156
TP (g/L)	65~85	58	48	50	56	55	60
ALB (g/L)	40~55	32	27	31	33	35	34
TBA(μmol/L)	0.0~20.0	25.1	18.11	7.78	4.82	3.38	2.81

项目	正常范围	1 d	2 d	3 d	4 d	5 d	6 d
AST(U/L)	13~35	46	33	30	27	28	25
ALT(U/L)	7~40	268	178	176	130	91	54
TBI(μmol/L)	3.0~21.0	62.7	70.2	55.9	40.9	35.6	23.2
DBI(μmol/L)	0.0~7.0	44.6	49.8	39.2	27.7	22.9	15.3
IBIL(μmol/L)	3.0~14.0	18.1	20.4	16.7	13.2	12.7	7.9
CHE(U/L)	4000~13000	3598	3027	3491	3706	4047	4156
TP (g/L)	65~85	58	48	50	56	55	60
ALB (g/L)	40~55	32	27	31	33	35	34
TBA(μmol/L)	0.0~20.0	25.1	18.11	7.78	4.82	3.38	2.81

项目	正常范围	1 d	2 d	3 d	4 d	5 d	6 d
Urea(mmol/L)	2.5~6.1	53.33	23.9	12.8	7.5	6.8	2.9
Crea(μmol/L)	46~92	1033	551	309	235	171	93
UA(μmol/L)	149~466	756	386	323	85	45	30
CO₂CP(mmol/L)	22~30	11	16	24	27	29	26
尿量 (ml/24 h)		小于30 ml	405	550	1120	3050	2540