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目的 :观察毒鼠强中毒患者免疫功能状态以及血液灌流联合连续性血液净化 (CBP)对毒素的清除及相应的免疫功能变化。 方法 :12例重度毒鼠强中毒患者行活性炭血液灌流 (HP)联合连续性静脉 静脉血液滤过 ,在治疗前 (0h) ,12h ,2 4h ,4 8h及 72h取抗凝血 ,分离单核细胞 ,细菌脂多糖 (LPS) 10 μg/ml刺激 12h ,测定其分泌的细胞因子水平 (TNF α、IL 6、IL 10 ) (ELISA) ,同时观察外周血单核细胞、淋巴细胞数量变化 ,并测定血浆中各种细胞因子水平。 结果 :①HP联合CBP治疗能显著降低血中毒鼠强浓度 (P <0 0 5 )。②与正常人相比 ,所有中毒患者单核细胞分泌的细胞因子明显减少 ,其中TNF α和IL 10 (P <0 0 1)为著。③HP联合CBP治疗后大多数患者临床表现明显改善 ,单核细胞分泌功能逐渐恢复正常 (P <0 0 5 )。少数患者单核细胞分泌功能则进一步减退 (P <0 0 5 ) ,并伴细胞数量明显减少 (P <0 0 1) ,这些患者血中毒鼠强浓度高 ,救治时间较晚 ,免疫功能处于严重抑制状态 ,患者预后极差。 结论 :①HP联合CBP治疗后 ,能快速、持续地清除毒鼠强 ;②与其他创伤、烧伤、炎症不同 ,毒鼠强中毒患者单核细胞免疫功能呈严重低下状态。随着毒素被清除 ,大多数患者免疫功能逐渐恢复 ,临床症状明显改善 ;③患者预
Objective: To observe the immune function of tetramine poisoning patients and the combination of hemoperfusion and continuous blood purification (CBP) to remove toxins and corresponding immune function changes. Methods: Twelve patients with severe tetramine poisoning underwent active blood perfusion (HP) and continuous venous venous hemofiltration before anticoagulant therapy (0h, 12h, 24h, 48h and 72h) The levels of cytokines (TNFα, IL 6, IL 10) secreted by lipopolysaccharide and lipopolysaccharide (LPS) were measured after stimulation with 10 μg / ml for 12 hours. The numbers of peripheral blood mononuclear cells and lymphocytes were also observed. Determination of plasma levels of various cytokines. Results: ①HP combined with CBP significantly reduced the concentration of blood poisoning rats (P <0 05). ②Compared with normal subjects, cytokines secreted by monocytes in all poisoned patients decreased significantly, with TNFα and IL-10 (P <0.01). The clinical manifestations of most patients after HP combined with CBP were significantly improved, monocyte secretion gradually returned to normal (P <0 05). A small number of patients with monocyte secretion was further decreased (P <0 05), accompanied by a significant reduction in the number of cells (P 0 01), these patients with high concentration of blood poisoned rats, treatment time later, the immune function in Seriously inhibit the status of patients with poor prognosis. Conclusion: ①HP combined with CBP treatment can rapidly and continuously remove tetramine poisoning; ②Compared with other trauma, burns and inflammation, mononuclear cells immunodeficiency in patients with tetramine poisoning is severely depressed. As the toxins were removed, the immune function of most patients gradually recovered and the clinical symptoms improved obviously. ③ The patients’