同时,双连续的毒性血液过作为重症酸中毒的救援疗法
Aminah Hussan1, Ifrah Hasan1, Reem El-Hayani1
1King's College London Guy's Campus, Great Maze Pond, London SE1 1UL, UK.
双连续静脉血过 (CVVHDF) 有效治疗严重的甲过量,改善了酸性和乳酸盐水平. 这种先进的技术为危急病患者提供了可行的救生疗法,当标准方法不足时.
科学领域:
- 毒理学 毒理学 毒理学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 临界护理医学 临界护理医学
背景情况:
- 严重的甲过量可以导致中枢神经系统的抑郁,大脑,以及代谢性酸性化.
- 建议进行体外切除,例如间歇性血液透析,但对于血液动力学不稳定的重症监护室患者来说,这往往是不可行的.
- 像液体和L-卡尼丁这样的标准治疗在严重情况下可能只能提供边际改善.
研究的目的:
- 关于成功使用双连续毒静脉血过 (CVVHDF) 治疗大规模甲过量症的案例报告.
- 评估双CVVHDF在改善对初始治疗无反应的严重代谢性酸和高乳糖血症的疗效.
- 突出双CVVHDF作为严重的氨酸毒性潜在的救援疗法.
主要方法:
- 一个年轻的成年男性有大量的故意过量甲 (13g) 呈现出严重的酸和缺氧.
- 最初的治疗包括液体和L-卡尼丁,但成功程度有限.
- 随后,该患者接受了持续毒性血过 (CVVHDF) 治疗,由于持续的酸性和高乳糖血症,患者升级为双重CVVHDF.
主要成果:
- 双CVVHDF在单过器CVVHDF的26小时后以最大96毫升/千克/小时的废水速度启动.
- 在31小时的双重CVVHDF治疗期间,观察到代谢酸和乳酸盐水平的显著改善.
- 患者的病情在转换回单过CVVHDF20小时后得到改善.
结论:
- 双CVVHDF促进了更高的废水流速,在严重的甲过量中证明有效.
- 这一案例支持双CVVHDF作为耐火代谢酸化症和高乳糖血症在氨酸毒性的可行和潜在的救命救援疗法.
- 在管理复杂过量病例时,应考虑持续性置换疗法,特别是双重CVVHDF.
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