高强度血液灌流联合长时程血液滤过在百草枯中毒救治中的应用:1例报告

Intensive hemoperfusion and long-term hemofiltration for treatment of paraquat poisoning:a case report

对1例口服50 m L百草枯后继发急性肾损伤的患者,在常规药物治疗基础上予连续9 d血液灌流(hemoperfusion,HP)和10 d连续性肾替代治疗(continuous renal replacement therapy,CRRT),模式为持续静脉-静脉血液滤过(continuous veno-venous hemofiltration,CVVH)。治疗后患者各项指标好转,血及尿百草枯浓度下降,尿量增加,血肌酐下降,氧合指数正常,患者出院后血肌酐水平逐渐恢复正常,动态胸部CT检查显示肺间质性炎性病变逐渐减轻,无明显肺纤维化表现,随访半年,患者无不适。该个案提示早期开始的高强度血液灌流联合长时程血液滤过可能会更好地改善百草枯中毒患者预后。

A 20-year-old male patient was admitted in our department 14 h after paraquat poisoning at the dose of about 50 mL.The patient underwent intensive hemoperfusion for 2 h（3 times a day） for 9 consecutive days and received continuous renal replacement therapy（CRRT） in the mode of continuous veno-venous hemofiltration（CVVH） for 10 consecutive days in addition to routine medications. The biochemical indexes were monitored during the therapy. After the treatment, paraquat concentrations in the blood and urine were decreased, and the patient＇s urine volume（UV） increased, serum creatinine（Cr）level decreased, and the oxygenation index became normal. Dynamic CT scan showed no obvious pulmonary fibrosis. The patient was followed up for 6 months after discharge and no complaint of discomforts was reported. This case suggests that early intensive hemoperfusion and long-term CVVH may help improve the prognosis after paraquat poisoning.