血液灌流联合环磷酰胺救治百草枯中毒疗效观察

A study on therapeutic effect of hemoperfusion combined with cyclophosphamide in treatment of acute paraquat poisoning

目的 探讨血液灌流（HP）联合环磷酰胺对急性百草枯中毒的疗效.方法 回顾性分析本院2007年7月至2010年2月确诊的104例急性百草枯中毒患者病历资料,将患者按治疗方法不同分成3组,常规治疗组（A组,37例）,常规治疗加HP组（B组,33例）,常规治疗加HP联合环磷酰胺治疗组（C组,34例）.治疗3周后观察患者肝、肾、心功能指标,评价器官损害情况及预后.结果 3组患者性别、年龄及服药剂量比较差异无统计学意义（均P〉0.05）.A组死亡31例,B组死亡15例,C组死亡12例（P=0.00）;B组、C组死亡病例存活时间明显长于A组[（8.13±4.03） d、（9.67±4.12） d比（2.99±2.10） d,均P〈0.01],B组与C组比较差异无统计学意义（P〉0.05）.B组肝、肾、心功能损害发生率明显低于A组（P〈0.05或P〈0.01）;C组略低于B组,但差异无统计学意义（P〉0.05）.结论 采用HP联合环磷酰胺治疗可以减轻百草枯对患者各器官的损害,降低患者病死率.

Objective To investigate the therapeutic effect of hemoperfusion （HP） combined with cyclophosphamide in the treatment of acute paraquat poisoning. Methods The data of 104 cases with acute paraquat poisoning from July 2007 to February 2010 in Emergency Department of Affiliated Hospital of Binzhou Medical College were retrospectively reviewed. The patients were divided into three groups： conventional strategy group （A group, 37 cases）, conventional strategy and HP group （B group, 33 cases） and conventional strategy and HP combined with cyelophosphamide group （C group, 34 cases）. The functional statuses of liver, renal and heart were compared at 3 weeks of treatment. The damage of organ and prognosis were evaluated. Results There were no significant differences in gender, age and poisoning dose among the three groups （all P〈0. 05）. There were 31 deaths in A group, 15 in B group and 12 in C group （P=0.00）. The survival times of dead cases in B and C groups were longer than the time in A group [（8.13±4.03） days, （9. 67±4.12） days vs. （2.99±2. 10） days, both P〈0. 01], and there was no statistical significant difference between B group and C group （P〉0.05）. The dysfunction rates of liver, renal and heart in B group and C group were lower than that in A group （P〈0.05 or P〈0.01）, and the rate in C group was slightly lower than tbat in B group, but no statistical significant difference was seen. Conclusion HP combined with cyclophosphamide can decrease the patients＇ organic impairment in acute paraquat poisoning, and reduce the case fatality rate.