依达拉奉联合杂合式血液净化在急性百草枯中毒并发急性呼吸窘迫综合征治疗中的作用

Effect of edaravone combined with HRRT on the treatment of patients with acute paraquat poisoning and ARDS

目的探讨依达拉奉联合杂合式血液净化在急性百草枯中毒并发急性呼吸窘迫综合征（ARDS）治疗中的作用，旨在为其临床治疗提供参考。方法选取急性百草枯中毒并发ARDS患者85例，采取抛掷硬币法将其分人观察组（43例）和对照组（42例）。对照组予以急性百草枯中毒、ARDS的常规治疗措施。观察组在此基础上，予以依达拉奉联合杂合式血液净化治疗。比较两组中1周内病死率、死亡时间及原因，于治疗前及治疗后1、3、7d进行急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）、序贯器官功能衰竭评分（SOFA），并检测血浆丙二醛（MDA）和超氧化物歧化酶（SOD）水平。结果入院1周内，观察组与对照组病死率分别为46．51％、71．43％（X2=5．45，P〈0．05），观察组ARDS病死率低于对照组（X2=4．57，P〈0．05）。治疗后3、7d，观察组APACHE Ⅱ评分、血浆MDA水平均降低，SOFA评分及血浆SOD水平均升高（t=3．96～7．11，P〈0．05或P〈0．01）；治疗后7d，对照组APACHE Ⅱ评分、血浆MDA水平均降低，SOFA评分及血浆SOD水平均升高（t=3．65～4．97，P〈0．05）。治疗后3、7d，观察组APACHE Ⅱ评分、血浆MDA水平均低于对照组，SOFA评分及血浆SOD水平均高于对照组（t=3．87～4．39，P〈0．05）。结论依达拉奉联合杂合式血液净化在急性百草枯中毒并发ARDS治疗中具有较好的临床疗效，有效清除了百草枯毒素和氧自由基等，降低了血浆MDA水平，提高了SOD水平，降低了ARDS病死率及总体病死率，优于临床常规治疗措施，对急性百草枯中毒并发ARDS的临床治疗具有一定的借鉴意义。

Objective To explore the effect of edaravone combined with HRRT on treatment of patients with acute paraquat poisoning and acute respiratory distress syndrome （ARDS）, to provide reference to its clinical treatment. Methods A total of 85 cases with acute paraquat poisoning and ARDS were selected, and were divided into observation group with 43 cases and control group with 42 patients. Patients in control group were given conventional treatment of acute paraquat poisoning and ARDS, and patients in observation group were given edaravone combined with HRRT. Mortality in a week, death time and reasons, also score of acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ ） and sequential organ failure assessment （SOFA）, plasma malondialdehyde （MDA） and superoxide dismutase （SOD） before treatment, 1, 3, 7 days after treatment in two groups were compared. Results One week after admission, mortality rates in observation group and control group were 46.51%, 71.43% （X2= 5.45, P 〈 0.05）, and ARDS mortality rate in observation group was lower than that in control group （X2 = 4.57, P 〈 0.05）. 3, 7 days after treatment, APACHE Ⅱ and plasma MDA were all decreased, and SOFA and plasma SOD were all increased in observation group （t = 3.96-7.11, P 〈 0.05 or P 〈 0.01 ）. 7 days after treatment, APACHEⅡ and plasma MDA were both decreased, and SOFA and plasma SOD were both increased in control group （t = 3.65-4.97, P 〈 0.05）. On 3 days, 7 days after treatment, APACHE Ⅱ and plasma MDA in observation group were all higher than that in control group, and SOFA and plasma SOD were all lower than that in control group （t = 3.87-4.39, P 〈 0.05）. Conclusion It has good clinical effect on the treatment of patients with acute paraquat poisoning and ARDS by edaravone combined with HRRT, effectively removes paraquat toxins and oxygen free radicals, reduces plasma MDA levels, improves SOD levels, decreases ARDS mortality and overall mortality, and it is superior to conventional treatment, so it has some reference meaning to treatment of acute paraquat poisoning and ARDS.