目的:分析急性重度砷化氢中毒患者的临床症状和以血液净化为主的治疗方法的疗效。方法:回顾分析2011年8月—2012年11月本院救治的4例急性重度砷化氢中毒患者的临床资料和治疗效果。结果:4例均在吸入砷化氢气体后4~7 h后出现临床症状,均有头晕、恶心、呕吐、寒战伴腰背痛、酱油色尿。2例在4 h后即出现严重的呼吸困难伴咳血性泡沫痰。2天后,4例皮肤均呈现青铜色或暗褐色,口唇苍白,出现肝脏肿大。尿常规:4例均出现尿蛋白(++)~(+++),尿潜血(++)~(+++)。4例心电图显示:窦性心动过速伴ST段下移,T波低平。血气分析:4例均出现代谢性酸中毒,p H值7.18~7.25,碱剩余(BE)-8~-15 mmol/L。2例出现严重的低氧血症,氧合指数<200 mm Hg。主要救治措施:(1)血浆置换(PE):4例在发病后72~96 h进行了血浆置换,每日一次,1~2日,每次使用血浆分离器(PF 1000)滤出2000 ml暗褐色血浆,补充病毒灭活血浆1200~1600 ml,余量为5%人血白蛋白替代(总量2000 ml)。(2)连续肾脏替代疗法(CRRT)/间歇性血液透析(IHD):4例入院时均已出现急性肾损伤,除血浆置换,余时间给予持续性静脉血液透析滤过(CVVHDF)治疗,待生命体征稳定后改为间歇性血液透析治疗。患者3在发病102 h、患者4在病程第6天都因循环衰竭死亡,患者2在发病一周后肾功能逐渐恢复,患者1转为慢性肾衰竭,转回当地治疗,随访1.5年肾功能未恢复。患者平均住院时间12.5天。结论:急性重度砷化氢中毒可引起人体重要脏器损伤,尽早进行以血浆置换为主的血液净化治疗是目前较为有效的抢救方法。 OBJECTIVE: To analyze the clinical symptoms and treatment of patients with acute severe arsine poisoning treated with blood purification. Methods: The clinical data and therapeutic effects of 4 acute severe arsine poisoning patients treated in our hospital from August 2011 to November 2012 were retrospectively analyzed. Results: All 4 patients had clinical symptoms 4 ~ 7 h after inhalation of arsine gas. All of them had dizziness, nausea, vomiting, chills and low back pain and soy sauce color. Two patients developed severe dyspnea with cough and bloody sputum after 4 hours. After 2 days, 4 cases of skin showed bronze or dark brown, pale lips, enlarged liver. Urine routine: Urinary protein (++) ~ (+++), urinary occult blood (++) ~ (+++) were all found in 4 cases. 4 cases of ECG showed: sinus tachycardia with ST segment down, T wave low flat. Blood gas analysis: all 4 patients had metabolic acidosis, p H value 7.18 ~ 7.25, the remaining base (BE) -8 ~ -15 mmol / L. Two patients experienced severe hypoxemia with an oxygenation index <200 mm Hg. The main treatment measures: (1) plasma exchange (PE): 4 cases of 72 ~ 96 h after the onset of plasma exchange, once a day, 1 to 2 days, each time using a plasma separator (PF 1000) filter out 2000 ml Dark brown plasma supplemented with virus inactivated plasma 1200 ~ 1600 ml, the balance of 5% human serum albumin replacement (total 2000 ml). (2) CRRT / Intermittent Hemodialysis (IHD): All 4 patients had acute renal injury on admission. Except for plasma exchange, the patients were treated with continuous venous hemodiafiltration (CVVHDF) Vital signs changed to intermittent hemodialysis treatment. Patient 3 died of circulatory failure on the 6th day of the course of disease at the onset of 102 h. Patient 2 gradually recovered from renal failure one week after the onset of disease. Patient 1 switched to chronic renal failure and returned to local treatment. The follow-up of 1.5 years of renal failure restore. The average hospital stay was 12.5 days. Conclusion: Acute severe arsine poisoning can cause damage to vital organs in human body. It is an effective method to treat blood purification with plasma exchange as early as possible.