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目的探究群发性急性砷化氢中毒的临床特点及治疗。方法采用单纯药物及血浆置换等不同方法对36例急性群发性砷化氢中毒患者进行治疗,观察其急性溶血、肝脏、肾脏、心脏酶学等动态变化,以及血、尿砷浓度的清除情况。结果急性砷化氢中毒临床表现明显的接触时间-效应关系,血砷与尿砷浓度呈显著线性相关(r=0．718,P=0．019)。但血砷、尿砷浓度与临床中毒程度无明显相关性,血砷、尿砷浓度与肌酸激酶(CK)、乳酸脱氢酶(LDH)、碱性磷酸酶(ALP)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、α-羟丁酸脱氢酶(HHBD)、间接胆红素(TBIL)、直接红素(DBIL)、尿素氮(BUN)、肌酐(Cr)等均无相关性(P＞0．05)；血浆置换治疗可快速控制溶血继续发生(24 h内溶血控制),缩短急性肾功能衰竭少尿期,同时血HBDH、AST、LDH、CK、IBIL、DBIL、BUN在治疗后12～72 h内快速下降(P＜0．05)。结论轻度急性砷化氢中毒单纯药物治疗预后良好,对急性重度砷化氢中毒血浆置换是治疗的有效手段之一,宜尽早使用。
Objective To investigate the clinical characteristics and treatment of massive acute arsine poisoning. Methods Thirty-six patients with acute arsophageal arsine poisoning were treated with drugs and plasma exchange. The changes of acute hemolysis, liver, kidney and cardiac enzymes, as well as the clearance of blood and urine arsenic were observed. Results The clinical manifestations of acute arsine poisoning showed obvious contact time-effect relationship. There was a significant linear correlation between blood arsenic and urine arsenic (r = 0.718, P = 0.019). However, there was no significant correlation between arsenic and arsenic concentrations in blood and clinical toxicosis. The levels of arsenic and arsenic in blood were negatively correlated with creatine kinase (CK), lactate dehydrogenase (LDH), alkaline phosphatase (ALP) (ALT, AST, HHBD, TBIL, DBIL, BUN, Creatinine (Cr) and so on (P> 0.05). Plasma exchange therapy could rapidly control the hemolysis to continue (hemolytic control within 24 h), shorten the oliguria period of acute renal failure, and blood HBDH, AST, LDH , CK, IBIL, DBIL and BUN decreased rapidly within 12-72 h after treatment (P <0.05). Conclusion The mild acute arsine poisoning drug therapy with a good prognosis, acute severe arsine plasma exchange is an effective means of treatment, should be used as soon as possible.