[1]陆湛,陈艳波,黄波,等.混合型鹅膏菌中毒伴横纹肌溶解4例临床分析[J].南方医科大学学报,2018,(05):635.
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混合型鹅膏菌中毒伴横纹肌溶解4例临床分析()
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《南方医科大学学报》[ISSN:/CN:]

卷:
期数:
2018年05期
页码:
635
栏目:
出版日期:
2018-05-15

文章信息/Info

Title:
Mixed amanita phalloides poisoning with rhabdomyolysis: analysis of 4 cases
作者:
陆湛陈艳波黄波彭升王倩文刘丹蕾王华
关键词:
血液滤过血液灌流血浆置换鹅膏菌中毒
Keywords:
hemofiltration hemoperfusion plasma exchange amanita phalloides poisoning
摘要:
报告4例罕见灰花纹鹅膏菌和裂皮鹅膏菌混合型中毒伴横纹肌溶解患者的临床特点、救治方法与转归,综述中毒机制和 救治方法进展。鹅膏菌中毒潜伏时间约8 h,病情严重程度与误食量有关。病变进展迅速,3~4 d出现多器官功能损害,以肝、肾 和神经系统损害为主,伴有急性胃肠损伤和横纹肌溶解。治疗均给予催吐、洗胃、利尿和导泻,行持续性血液净化和血液灌流序 贯治疗,共5~7 d,血液灌流1~2次/d。2例行血浆置换,1次/d,共2~3次。其他治疗包括糖皮质激素、大剂量维生素和葡萄糖溶 液等。结果治愈2例,死亡2例。死亡原因为鹅膏菌摄入过量、缺少早期针对性治疗和多器官功能损害较为严重。早期催吐、洗 胃、利尿和导泻清除体内鹅膏毒肽、打断肝肠循环是控制病情发展的关键。血液净化联合血液灌流序贯治疗可有效清除或吸附 鹅膏菌毒肽、防止器官功能进一步衰竭。
Abstract:
We report the clinical characteristics, treatments and outcomes of 4 rare cases of mixed amanita fuliginea and amanita rimosa poisoning with rhabdomyolysis, and review the research progress in the intoxication mechanism and treatment. The latent time of amanita poisoning, defined as the period from the ingestion of poisonous mushroom to the onset of gastrointestinal symptoms, was about 8 days, and the severity of poisoning was associated with the amount of mushroom ingested. All the 4 patients developed multiple organ dysfunctions within 3 to 4 days after mushroom ingestion, predominantly in the liver, kidney and central nervous system accompanied with acute gastrointestinal injury and rhabdomyolysis. The treatment measures included persistent hemofiltration and intermittent hemoperfusion once daily for 5-7 days, and plasma exchange was administered in 2 cases for 1 or 2 times. High-dose vitamin C, glucose and corticosteroid were also given to the patients. After the treatments, two patients were cured and the other two died due to an excess intake of poisonous mushroom and lack of early preemptive therapies. Early emetic, gastric lavage, catharsis, fluid infusion and diuresis are critical to interrupt the enterohepatic circulation of amanita phalloides toxins and prevent the development of multiple organ dysfunction. Enhanced hemofiltration and sequential plasma therapy might effectively eliminate toxin from the blood to protect against further organ damages.

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更新日期/Last Update: 1900-01-01