环孢素A和连续性静脉-静脉血液滤过对急性口服中重度百草枯中毒的疗效评价

The effectiveness of continuous veno-venous hemofiltration therapy in patients with moderate to severe paraquat poisoning

目的:评价环孢素A和连续性静脉-静脉血液净化(CVVH)对急性口服中重度百草枯(PQ)中毒患者的疗效。方法:采用单中心前瞻性随机对照研究,对85例急性口服中重度PQ中毒患者依据随机数字法随机分成对照组(甲强龙治疗组,26例)、试验组一(甲强龙加环孢素治疗组,31例)和试验组二(甲强龙加环孢素加CVVH治疗组,28例),分析3组患者的病死率、死亡患者的存活时间、30d生存曲线、脏器损伤情况情况。结果:3组患者在性别、服毒量、就诊时间、血PQ浓度、入院时肝肾功能和动脉血氧分压差异均无统计学意义。3组患者肾损伤发生率、肾损伤发生时间、肝损伤发生时间、低氧血症发生时间及死亡患者存活天数差异均具有统计学意义(均P<0.01);3组患者病死率差异无统计学意义(P>0.05),但病死率呈逐渐下降趋势,其中试验组二死亡率分别低于对照组、试验组一分别达26.3%、16.2%;3组患者30d生存曲线分析差异有统计学意义(P<0.05)。结论:CVVH可降低急性中重度PQ中毒患者病死率,延长死亡患者的生存时间,并延长发生肝、肾损伤及低氧血症发生时间,因此CVVH对中重度PQ中毒治疗有效。

Objective：To evaluate the effectiveness of cyclosporin A combined with continuous veno-venous hemofiltration therapy in patients with moderate to severe paraquat poisoning.Method：A single-center,prospective,randomized and controlled trial was carried out,a total of 85 patients with acute moderate to severe PQ poisoning was randomly grouped into control group（methylprednisolone only group,n=26）and trial group one（methylprednisolone＋cyclosporine Treatment group,n=31）and trial group two（methylprednisolone ＋ cyclosporin ＋CVVH treatment group,n=28）according to random number table method.The mortality,survival time,30 days survival curve,and viscera damage occurrence rate were analyzed.Result：There were no significant difference among the three groups in gender,ingested amount,time of arrived ED,blood PQ concentration,liver and kidney function and arterial oxygen pressure at admission.The incidence of renal injury,the time of renal injury,the time of liver injury,the time of hypoxemia and the number of surviving days of death in the three groups were all statistically different（P〈0.01,respectively）,while there was no significant difference in the mortality among the three groups（P〈0.05）,however,there had a gradual downward trend with mortality among those groups,the trial group two had more lower mortality than the other two groups（26.3% lower than control group,16.2% lower than trial group,respectively）,evenmore,there were significant difference among the three groups in 30-day survival curve（Log-rank P〈0.05）.Conclusion：CVVH can reduce the mortality of patients with acute moderate to severe PQ poisoning,prolong the survival time of died patient,and extend the time of the liver and kidney injuried and hypoxemia.Therefore,CVVH on the treatment of moderate to severe PQ poisoning was effective.