单次血液净化联合甲泼尼龙琥珀酸钠、环磷酰胺与肿瘤坏死因子受体-抗体融合蛋白治疗百草枯中毒效果

THE EFFECT OF SINGLE BLOOD PURIFICATION COMBINED WITH METHYLPREDNISOLONE SODIUM SUCCINATE,CYCLOPHOSPHAMIDE AND rhTNFR:Fc ON PARAQUAT POISONING

目的探讨单次血液净化联合甲泼尼龙琥珀酸钠、环磷酰胺及重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白治疗百草枯中毒的效果。方法2007年4月—2009年7月,我院对21例百草枯中毒病人(治疗组)采用单次血液净化联合甲泼尼龙琥珀酸钠、环磷酰胺及重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白进行治疗;2003年3月—2007年3月,对19例百草枯中毒病人(对照组)采用多次血液净化联合地塞米松、环磷酰胺等药物治疗;比较两组病人的病死率、住院天数、出院或死亡时的动脉血氧分压。结果治疗组死亡4例,病死率19.05%;对照组死亡17例,病死率89.47%,两组病死率比较差异有显著性(χ2=20.74,P<0.001);两组病人住院天数比较差异有显著性(t=-8.82,P<0.001);两组出院或死亡时动脉血氧分压比较差异有显著性(Z=-3.40,P<0.001)。结论单次血液净化联合甲泼尼龙琥珀酸钠、环磷酰胺及重组人Ⅱ型肿瘤坏死因子受体抗-体融合蛋白治疗百草枯中毒可以显著降低病人的病死率。

Objective To investigate the effect of single blood purification （SBP） combined with methylprednisolone sodium suecinate （MSS）, cyelophosphamide and recombinant human tumor necrosis factor-α Receptor II ：IgG Fc fusion protein （rhT NFR：Fc） on paraquat poisoning. Methods From April 2007 to July 2009, 21 patients with paraquat poisoning were treated by SBP combined with MSS, cyclophosphamide and rhTNFR：Fe were classified as treatment group; the other 19 patients treated with multiple blood purification （MBP）, dexamethasone and eyclophosphamide from March 2003 to April 2007 served as the control. The case fatality, hospital day, and the arterial partial pressure of oxygen （PaO2） on discharge or at death between the two groups were compared. Results Four died in the treatment group, and 17 in the control, the mortality rates were 19. 05% and 89.47 %, respectively. The difference of the death rate was significant （χ^2= 20.74, P〈0. 001）. The differences were also significant between the two groups in terms of hospital day （t =-8.82, P〈0. 001）, and the PaOz on discharge or at death （Z=- 3.40, P〈0. 001）. Conclusion The combination therapy by single blood purification combined with methylprednisolone sodium succihate, cyelophosphamlde and rhTNFR： Fc can significantly reduce the mortality rate in patients with paraquat poisoning.