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目的本研究观察血液灌流(Hemoperfusion,HP)治疗中毒的效果,组织毒物再释放时间,HP 和非 HP 期的毒代动力学,HP 对血细胞和血生化的影响,儿童 HP 中应用肝素剂量和血流量等。方法 35例中毒儿童[男26例,女9例,年龄10个月～13岁,平均年龄(3.35±2.50)岁]接受HP 治疗1～3次,其中12例2次,4例3次。收集氟乙酰胺(FAM)中毒6例和毒鼠强(TET)中毒10例病人血2ml,用气相色谱法(GC 法)检测毒物浓度。结果 HP 后所有病例中毒症状缓解或明显减轻,27例(77%)中毒儿童治愈,6例(17%)好转,2例(6%)死因多脏器衰竭。4例已缓解的病例在HP 后6～24 h 症状反复,其中 FAM 1例,TET 3例。HP 后血小板、红细胞和血红蛋白降低,P<0.05;HP 前后 WBC、血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、尿素氮(BUN)、肌酐(CRE)和总白(TP)、总白(ALB)、球蛋白(GLO)等值比较无显著差异性,P>0.05。检测 FAM 和 TET 中毒儿童在 HP 前,HP 治疗60、120 min FAM 量(ng/ml)分别是309.00±114.75,254.67±128.15和230.00±107.53,χ~2=7.000,df=2,P<0.030;TET 量(ng/ml)分别是216.10±59.07,176.20±47.30和161.00±31.49,χ~2=13.400,df=2,P=0.001。HP1 h 较 HP 前下降值 FAM 是54.33(17.58%),TET 是39.9(18.46%),HP 2 h 较 HP 1 h 下降 FAM 是24.67(7.98%),TET 是15.2(7.03%),HP 2 h 使 FAM 和 TET 浓度下降25.57%和25.50%,HP 第1小时下降速度快于第2小时;HP 后2～6 h,4例(FAM 1例,TET 3例)已降低的毒物血浓度回升,但低于 HP 前水平;FAM 和 TET 的 t_(1/2)在 HP 期和非 HP 期分别为(2.40±0.66)h,(15.60±8.22)h 和(4.10±1.66)h,(67.01±48.42)h。HP 首次肝素平均剂量(0.54±0.15)mg/kg;每30 min 追加(0.20±0.06)mg/kg;血流量(4.39±0.99)ml/min。结论 HP 使毒物代谢消除 t_(1/2)明显缩短,能安全、有效地治疗中毒患者;HP 后2～6 h 部分患者血浓度可能有短暂性回升;活性炭 HP 不能吸附与血浆白蛋白和球蛋白结合的毒物;活性炭 HP 可造成一过性血小板、红细胞不同程度的破坏。肝素用量应小于成人。
ObjectiveTo study the effect of Hemoperfusion (HP) on the poisoning, the re-release time of tissue toxicants, the toxicokinetics of HP and non-HP, the effect of HP on blood cells and blood biochemistry, and the application of heparin dose and blood Traffic and so on. Methods Thirty-five poisoned children [26 males and 9 females aged from 10 months to 13 years (mean age 3.35 ± 2.50) were treated with HP 1 to 3 times, 12 in 2 and 3 in 4). Six cases of FAM poisoning and two cases of TET poisoning were collected, and the concentration of poison was detected by gas chromatography (GC). Results The symptoms of poisoning in all cases were relieved or significantly reduced after HP. Twenty-seven children (77%) were cured of poisoning, 6 (17%) improved and 2 (6%) died of multiple organ failure. Four cases had been alleviated in 6 to 24 h after HP symptoms repeated, FAM in 1 case, TET in 3 cases. The levels of platelet, erythrocyte and hemoglobin in HepG2 cells were decreased after HP administration (P <0.05). The WBC, serum ALT, AST, creatine kinase (CK) and creatine kinase There was no significant difference in CK-MB, BUN, CRE and TP, total albumin (ALB), globulin (GLO), P> 0.05. The FAM levels (ng / ml) at 60 and 120 min after HP treatment in children with FAM and TET were 309.00 ± 114.75, 254.67 ± 128.15 and 230.00 ± 107.53, χ ~ 2 = 7.000, df = 2 and P <0.030 ; TET levels (ng / ml) were 216.10 ± 59.07,176.20 ± 47.30 and 161.00 ± 31.49, χ ~ 2 = 13.400, df = 2, P = 0.001. HP1 h decreased compared with pre-HP FAM was 54.33 (17.58%), TET was 39.9 (18.46%), HP 2 h decreased 1 h FH was 24.67 (7.98%), TET was 15.2 (7.03% The concentration of FAM and TET decreased by 25.57% and 25.50%, HP decreased more rapidly in the first hour than that in the second hour. After 2 ~ 6 h, the poisoned blood concentration of 4 cases (FAM, TET, 3 cases) decreased, But lower than the pre-HP level. The t 1/2 of FAM and TET were (2.40 ± 0.66) h, (15.60 ± 8.22) h and (4.10 ± 1.66) h, respectively 48.42) h. HP first-time heparin average dose (0.54 ± 0.15) mg / kg; every additional 30 minutes (0.20 ± 0.06) mg / kg; blood flow (4.39 ± 0.99) ml / min. Conclusion HP can make the t 1/2 (1/2) of drug metabolism shortened obviously and can safely and effectively treat patients with poisoning. The serum concentration of some patients may transiently rise 2 ~ 6 h after HP. Activated carbon HP can not adsorb with plasma albumin and ball Protein binding poison; activated carbon HP can cause transient platelet, red blood cell damage to varying degrees. The amount of heparin should be less than adults.