血液灌流联合血液透析治疗急性百草枯中毒的疗效

Efficacy of hemoperfusion combined with hemodialysis in treating acute paraquat poisoning

目的观察血液灌流联合血液透析治疗急性百草枯中毒的临床疗效。方法回顾性分析急性百草枯中毒91例患者的临床资料。在常规治疗基础上加用血液灌流联合血液透析治疗36例(A组)或加用血液灌流治疗25例(B组),单用常规内科治疗30例(C组)。91例中,中-重度百草枯中毒患者58例:A组23例(A1组),B组15例(B1组),C组20例(C1组)。比较不同治疗方法组的临床疗效。结果 A组和B组总有效率高于C组(63.9%和64.0%vs.26.7%)(P<0.05)。A1组和B1组病死率低于C1组(26.1%和53.3%vs.85.0%)(P<0.05),A1组病死率低于B1组(P<0.05)。A组第3天和第7天存活病例的胆红素和肌酐值低于B组和C组(P<0.05),第7天的PaO_2高于B组和C组(P<0.05)。结论在常规治疗的基础上,加用血液灌流联合血液透析治疗能有效减轻急性百草枯中毒,尤其是中-重度中毒患者的脏器功能损害,降低病死率。

Objective To observe the clinical efficacy of blood purification combined with hemoperfusion in the treatment of acute paraquat poisoning.Methods Clinical data of 91 cases with acute paraquat poisoning were retrospectively analyzed.On the bases of conventional treatments,36 patients（group A）were treated with additional hemoperfusion combined with hemodialysis and 25 cases（group B）were treated with additional hemoperfusion.The conventional treatments alone were performed in 20 cases（group C）.Of 91 cases,58 cases were diagnosed as moderate to severe paraquat poisoning,of whom 23 cases（group A1）were in group A,15 cases（group B1）were in group B and20 cases（group C1）were in group C.The clinical efficacy was compared among the patients with different therapeutic regimens.Results The overall effectiveness rate was higher in groups of A and B than that in group C（63.9%and 64.0% vs.26.7%）（P〈0.05）.The death rate was lower in groups of A1 and B1 than that in group C1（26.1% and 53.3% vs.85.0%）（P〈0.05）,which was lower in group A1 than that in group B1（P〈0.05）.Serum levels of bilirubin and creatinine on the 3 rd and 7 th day were lower,but PaO2 was higher,in the survival patients of group A than those of groups of B and C（P〈0.05）.Conclusion On the bases of conventional treatments,additionally use of hemoperfusion combined with hemodialysis can effectively attenuate the organs injury of the patients with acute paraquat poisoning,especially in those with moderate to severe paraquat poisoning,and reduce the death rate.