早期血液灌流救治急性百草枯中毒患者临床疗效分析

Analysis of clinic efficacy on early repeated hemoperfusion in patients with acute paraquat poisoning

目的分析168例急性百草枯中毒患者的临床资料，探讨早期反复血液灌流（HP）的疗效。方法收集2010年1月至2011年2月中国医科大学附属第一医院急诊监护室（EICU）收治的接受早期反复HP（服毒24h内接受HP≥2次）的81例急性百草枯中毒患者（A组）的临床资料，与2008年1月至2009年12月收治的87例患者（B组）进行对照研究，对早期反复HP的疗效进行分析。A组与B组除HP外接受统一的综合救治方案。应用SPSS13．0软件包，计量数据以均数±标准差（x-±s）表示，组间比较采用成组t检验，对计数资料进行X^2检验。结果168例患者均为口服百草枯农药急性中毒，A组81例，病死率64．2％，B组87例，病死率78．2％，两组病死率比较差异具有统计学意义（X。=4．01，P=0．042）。A组患者服毒至首次HP时间（3．6±3．3）h，服毒24h内平均接受HP（2．9±1．4）次。中毒后第2天开始，A组和B组患者SOFA评分均高于来诊时，中毒第3天、第4天A组患者的SOFA评分低于同日B组患者，差异具有统计学意义（P〈0．05）。A组和B组的患者比较，B组患者中ALT〉80U／L和TBIL〉34．2μmol／L的出现时间早于A组，差异具有统计学意义（P〈0．05）。B组患者中肌酐〉177μmol／L，PaO2〈60mmHg（1mmHg=0．133kPa）的患者所占的比例高于A组，且出现时间早于A组，差异具有统计学意义（P〈0．05）。B组患者ALT、TBIL、肌酐、AMY、肌酸激酶MB同工酶（CK-MB）的最高值比A组患者高，而B组患者PaO2最低值比A组患者低，差异具有统计学意义（P〈0．05）。结论早期反复HP可以延迟急性百草枯中毒后脏器损伤并减轻损伤程度，为进一步采取治疗措施赢得时间。

Objective To explore the clinic efficacy on early repeated hemoperfusion in patients with acute paraquat （PQ） poisoning by analyzing the clinical data of 168 patients. Methods A total of 168 patients with acute paraquat poisoning, admitted to our emergency intensive care unit （EICU） from January 2008 to February 2011 were retrospectively analyzed. The PQ poisoning patients were divided into HP group （n =81, group A） and non-HP group （n =87, group B）. The early repeated HP was carried out for at least 2 times within 24 hours after poisoning. The chi-square test and t test were used to detect the difference in outcome between groups. Results There were 52 patients （ 64. 2% ） in group A died and 68 fatalities （78. 2% ） in group B （X^2 =4. 01, P =0. 042）. The first HP was carried out in patients of group A within （3.6 ± 3.3） h after poisoning, and the patients in the group A received HP for （2. 9 ± 1.4） times. On the second day after poisoning, sequential organ failure assessment （SOFA） scores of 168 patients were higher than those at admission （P 〈 0.05）. SOFA scores of patients in the group A were higher than that in thegroup B on the third day and on the forth day （P 〈 0. 05 ）. In the group B, alanine aminotransferase （ALT） 〉 80 U/L and total bilirubin （TBIL） 〉 34.2 μmol/L occurred earlier than those in group A （P 〈 0. 05 ） and there were more patients with abnormal creatinine and arterial oxygen and those abnormalities occurred earlier than those in group A （P 〈 0. 05 ）. The maximum value of ALT, TBIL, creatinine, amylase （AMS） and CK-MB in the group B were higher than those in group A （P 〈 0.05）, the lowest value of PaO2 （ 〈 60 mm Hg） in group B were lower than that in group A （P 〈 0. 05 ）. Conclusions The early repeated HP can delay organ injury after acute paraquat poisoning and reduce the extent of injure, giving ample time to get advanced treatment measures to improve the prognosis of patients.