广州医科大学学报

目的:探讨血液灌流联合间歇性肾脏替代治疗对蝰蛇咬伤导致的急性肾功能衰竭的疗效。方法:2019年1月至8月我院收治17例蝰蛇蛇伤患者,以抗蝮蛇毒血清为主的内科综合治疗基础上,选择血液净化技术,采用间歇性肾脏替代治疗联合血液灌流进行抢救。分别于治疗前、行血液净化治疗2天,第5天,第20天抽血检测肝肾功能心肌酶学、PT、DII聚体,血小板水平,并观察血流动力学的变化,伤口愈合情况。结果:与治疗前相比较,患者经血液灌流联合间歇性肾脏替代治疗后,D-II聚体、肌红蛋白、LDH、ALT、CK、PT、TBi明显下降(P<0.05);但BUN、CR在HP+IRRT治疗前后差异无统计学意义(P>0.05);随后IRRT继续治疗BUN、CR呈进行性下降(P<0.05)。APACHEⅡ评分由治疗前22.6±5.3下降至8.3±3.4(P<0.05)。17例患者的临床治愈率为71.6%,有效率为23.5%,死亡率5.9%。结论:血液灌流串联间歇性肾脏替代治疗,二者能互相促进和弥补,可有效将各种有毒物质清除,为肾功能的恢复赢得时间,具有良好的预后效果,是一种安全有效的治疗方法。

Objective:To investigate the effect of hemoperfusion(HP)combined with intermittent renalreplacement(IRRT)on acute renal failure caused by viper bite.Methods:Seventeen patients with wounds causedby viper bite admitted to our hospital between January and August 2019 received blood purification on the basis ofcomprehensive medical treatment with anti-Agkistrodon venom serum as the main component. HP+IRRT was usedfor rescue. Blood sampling was performed at baseline,and at 2,5 and 20 d after blood purification. The liver andkidney functions,myocardial enzymology,PT,D-dimer,and platelet levels were examined. The changes inhemodynamics and wound healing were recorded.Results:The levels of D-dimer,myoglobin,LDH,ALT,CK,PTand TBi decreased significantly after HP+IRRT compared with baseline(allP<0.05). However,there were nosignificant differences in BUN and CR at baseline and after HP+IRRT treatment(bothP>0.05). Subsequently,the levels of BUN and CR showed a progressive decline after IRRT(bothP< 0.05). The APACHE II scoredecreased from 22.6±5.3 at baseline to 8.3±3.4(P<0.05). The clinical cure rate of 17 patients was 71.6%,theeffective rate was 23.5%,and the mortality rate was 5.9%.Conclusion:HP and IRRT may be mutually enhancingand complementary in effective elimination of various toxic substances in favor of the time gained for renalfunction recovery. Combination use of the both appears well-prognostic,and therapeutically safe and effective.