血液灌流联合高通量血液透析治疗急性农药或药物中毒临床分析

clinical analysis of hemoperfusion plus high-fiux hemodialysis therapy on patients with acute poisoning of agricultural chemicals or drugs

目的探讨血液灌流联合高通量血液透析(HP+HFHD)治疗农药或药物中毒的治疗效果以及影响患者预后的相关因素。方法对12例农药或药物中毒患者应用HP+HFHD,治疗前后观察血气分析、肝肾功能及凝血功能变化,并对患者进行APACHEIII评分。结果 HP+HDF治疗48h后,血PH值PaO_2、PaCO_2、SatO_2、ALT、AST、SCr均明显改善(P<0.05),血PLT较治疗前下降,PT和APTT较前延长(P<0.05)但未见出血现象;APACHEIII评分较治疗前降低(P<0.05)。12例患者中死亡4例,死亡率为33.3%(4/12)。其中4例百草枯中毒者3例死亡,死亡率75%(3/4)。结论除内科综合治疗外尽早加用血液灌流和高通量血液透析对急性农药或药物中毒抢救成功有明显的效果。

Objective To investigate the efficacy of Hemoperfusion plus high-flux hemodialysis（HP＋HFHD） therapy on patients of acute poisoning of agricultural chemicals or drugs and evaluate the influence factors.Methods 12 patients were treated in the form of HP＋HFHD.The concentration of ALT, AST,Scr,PLT,PT,APTT in blood as well as blood gas analysis,the acute physiology and chronic health evaluationⅢ（APACHEⅢ） were evaluated,and both results of before HP＋HFHD and 48h later were compared.Results After HP＋HFHD,the concentration of ALT,AST,Scr and blood gas analysis got much better（P0.05）,APACHEⅢscore and PLT were decreased significantly（P0.05）,and PT,APTT were prolong significantly.But the bleeding wasn thappen during HP＋HFHD.4 of all cases were dead,the mortality was 33.3%（4/12）.And 3 of 4 cases with paraquat poisoning were dead,the mortality was 75%（3/4）. Conclusion HP＋HFHD is effective and safe method for acute poisoning of agricultural chemicals or drugs;and it is practiced as early as possible,it would have distinct efficacy.