血液灌流联合连续性静-静脉血液滤过治疗百草枯中毒的效果观察

Effects of hemoperfusion combined with continuous veno-venous hemofiltration in patients with paraquat poisoning

目的探讨血液灌流(HP)联合连续性静-静脉血液滤过(CVVH)对百草枯中毒患者的治疗效果。方法回顾性分析2015年1月至2019年1月中国人民武装警察部队河南省总队医院收治的80例百草枯中毒患者的临床资料。根据治疗方式将患者分为HP组(对照组,n=41)和HP+CVVH组(观察组,n=39)。比较两组患者治疗前后血清百草枯水平及其清除率,观察治疗前后肝、肾功能[天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、尿素氮(BUN)、肌酐(Cr)]、肌酸激酶同工酶(CK-MB)、白细胞介素-8(IL-8)、动脉血乳酸(Lac)、氧合指数(PaCO2/FiO2)等指标变化情况,治疗前及治疗第2、4、6天对患者进行序贯器官衰竭估计评分(SOFA),比较两组患者30 d病死率,采取Kaplan-Meier法进行生存分析。结果治疗后72 h,两组患者血清PQ水平均较治疗前降低,且观察组低于对照组(P<0.05);AST、ALT、BUN、Cr、IL-8、CK-MB、Lac水平均较治疗前升高,且观察组低于对照组(P<0.05);PaCO2/FiO2较治疗前降低,且观察组高于对照组(P<0.05)。治疗第2、4、6天,两组患者SOFA评分均较治疗前升高,且观察组低于对照组(P<0.05)。观察组患者百草枯清除率高于对照组,30 d病死率低于对照组(P<0.05)。Kaplan-Meier分析结果显示,两组生存率比较差异有统计学意义(P<0.05)。结论HP联合CVVH治疗百草枯中毒的疗效优于单独HP治疗,可有效清除毒素,减少乳酸生成,减轻炎症反应和脏器功能损伤,延长生存时间,降低病死率。

Objective To investigate the effects of hemoperfusion(HP)combined with continuous veno-venous hemofiltration(CVVH)in patients with paraquat poisoning.Methods The clinical data of 80 patients with paraquat poisoning admitted to Henan General Hospital of the Chinese People’s Armed Police Force from January 2015 to January 2019 were retrospectively analyzed.Patients were divided into HP group(control group,n=41)and HP+CVVH group(observation group,n=39)according to the treatment methods.Serum paraquat poisoning level and clearance rate were compared between the two groups before and after treatment.Liver and kidney function,such as aspartate aminotransferase(AST),alanine aminotransferase(ALT),urea nitrogen(BUN),creatinine(Cr),creatine kinase isoenzyme(CK-MB),interleukin-8(IL-8),arterial blood lactate(Lac)and oxygenation index(PaCO2/FiO2)were observed before and after treatment.Before treatment and on the second,fourth and sixth day of treatment,the sequential organ failure assessment(SOFA)was scored,and the 30-day mortality rates were compared between the two groups,and Kaplan-Meier method was used for survival analysis.Results After 72 h of treatment,the serum paraquat poisoning level in the two groups was lower than that before treatment,and the level in observation group was lower than that in control group(P<0.05);the levels of AST,ALT,BUN,Cr,IL-8,CK-MB and Lac were increased compared with those before treatment in the two groups,and the levels in observation group were lower than those in control group(P<0.05).The PaCO2/FiO2 was lower than that before treatment,and the index in observation group was higher than that in control group(P<0.05).On the second,fourth and sixth day of treatment,the SOFA scores in the two groups were higher than those before treatment,and the score in observation group was lower than that in control group(P<0.05).The paraquat poisoning clearance rate in observation group was higher than that in control group while the 30-day mortality rate was lower than that in control group(P<0.05).Kaplan-Meier analysis results showed that there was a statistically significant difference in the survival rate between the two groups(P<0.05).Conclusions HP combined with CVVH has better efficacy in the treatment of paraquat poisoning than HP alone.And it can effectively remove toxins,reduce lactate production,alleviate inflammatory response and organ function damage,prolong survival time and reduce mortality rate.