血必净注射液联合血液滤过治疗急性百草枯中毒

Effect of treatment with Xuebijing injection （血必净注射液） and hemofiltration for patients with acute paraquat poisoning

目的观察血必净注射液联合血液滤过治疗急性百草枯中毒的临床疗效，指导建立急性百草枯中毒的有效治疗方案。方法回顾性分析本院2006年6月至2011年6月收治的39例急性百草枯中毒患者的临床资料，根据患者入院时的症状及器官功能情况分为3组。A组21例中毒量≤20ml，不伴有肝、肾、肺、心肌以及胰腺等重要器官功能损害；B组11例中毒量20-40ml，或入院时已经出现1个重要器官功能损害；C组7例中毒量≥40ml，或入院时已经出现2个或以上重要器官功能损害。再按照治疗方法不同将A组、B组患者分亚组进行分析。A1组入院后仅给予综合治疗，A2组、A3组、A4组在综合治疗基础上分别单用血必净或早期血液滤过以及联合治疗；B1组人院后给予综合治疗联合血液滤过，B2组在B1组基础上联合血必净治疗。c组患者给予综合治疗联合血必净和血液滤过。结果C组患者在中毒7d内全部死亡。A组、B组7d生存率差异无统计学意义（66．67％比45．45％，P〉0．10），A组14d、28d生存率显著高于B组（57．14％比18．18，38．10％比9．09％，均P〈0．10）。亚组分析中，与A1、A2、A3组比较，A4组患者28d存活率明显升高（33．33％比0、16．67％、25．00％，均P〈0．10），肝、肾、心、肺脏损伤发生率明显降低（肝：77．78％比100．00％、100．00％、100．00％，肾：66．67％比100．00％、83．33％、75．00％，心：55．56％比100．00％、100．00％、75．00％，肺：77．78％比100．00％、100．00％、100．00％）；A1组患者14d内全部死亡，器官功能恶化最重；A2组与A3组相当。B组28d存活的1例患者为血液滤过联合血必净治疗者。结论大剂量百草枯中毒病死率极高，出现多器官损害时预后极差。血必净注射液和早期血液滤过在一定程度上能改善轻中度急性百草枯中毒的预后，以早期血液滤过联合血必净注射液的效果最佳，并具有明显的器官保护作用。

Objective To observe the clinical effect of Xuebijing injection （血必净注射液） combined with hemofiltration for treatment of patients with acute paraquat intoxication and to establish an effective therapeutic scheme for the disease. Methods A retrospective analysis of clinical historical records was made, including 39 cases of paraquat poisoning in our hospital from June 2006 to June 2011. According to symptoms and organ damage on admission, they were divided into three groups： group A （21 cases） with less than 20 ml poisoning dose and without important organ damage, group B （11 cases） with poisoning dose between 20 ml and 40 ml or with one organ damaged （such as liver, kidney, heart, lung, pancreas, etc. ） and group C （7 cases） with poisoning dose over 40 ml or more than 2 organs damaged already. Group A and group B had been subdivided depending on the treatment. Comprehensive treatment given from the day of admission was the only treatment in group A1, and it was the basic treatment in A2, A3 and A4. In group A2 and group A3, Xuebijing injection or early hemofiltration was respectively used. In group A4, both Xuebijing injection and early hemofiltration were used. Group B1 had the treatment of comprehensive treatment and hemofiltration, and in group B2, besides the treatment in group B1, Xuebijing injection was also given. In group C, comprehensive therapy, hemofiltration and Xuebijing injection were used. Results All the cases in group C died in 7 days. The 7-day survival rate in group A and group B had no statistical significance （66.67% vs. 45.45%, P〉0. 10）, but the 14-day and 28-day survival rates of group A were significantly higher than those of group B （57.14% vs. 18.18, 38.10% vs. 9.09%, both P〈0. 10）. In the subgroup analyses, compared with group A1, group A2, group A3, the 28-day survival rate was much higher （33.33% vs. 0, 16.67%, 25.00%, P〈0.10）, and the incidences of liver, kidney, heart and lung injury were obviously reduced in group A4 （liver： 77.78% vs. 100.00%, 100.00%, 100.00% kidney： 66.67% vs. 100.00%, 83.33%, 75.00%3 heart： 55.56% vs. 100.00%, 100.00%, 75.00%; lung： 77.78% vs. 100.00%, 100.00%, 100. 00%）. All the cases died in 14 days, and the deterioration of organ function was the severest in group A1. Group A2 had a similar result as group A3. The only survival case in group B was the one treated with hemofiltration combined with Xuebijing injection. Conclusion The mortality of a case with a high dose of paraquat poisoning is significantly high, and when damage occurs in multiple organs, the prognosis is very bad. Xuebijing injection and early application of hemofiltration can improve the prognosis in certain degrees in cases with mild to moderate level of such intoxication, the best therapeutic effect can be obtained by using combination of them which possesses very obvious organ protective effect.