基于口服量的血液灌流强度对百草枯中毒患者预后的研究

Study of hemoperfusion intensity on prognosis in patients with paraquat poisoning based on oral administration amount

目的探讨血液灌流(HP)强度对不同口服量急性百草枯中毒患者预后的影响。方法回顾性分析2008年9月到2018年3月收入该院的612例急性百草枯中毒患者的病历资料,根据患者口服百草枯量将其分为小剂量组(口服量小于50 mL,n=376)和大剂量组(口服量大于或等于50 mL,n=236);再根据接受HP治疗强度进一步将患者分为低灌流强度(LHP)、中灌流强度(MHP)、高灌流强度(HHP)3个亚组;收集临床数据并分析。结果小剂量组中LHP、MHP、HHP治疗患者的7 d生存率分别为77.84%、88.46%、91.43%,28 d生存率分别为16.22%、42.95%、42.86%,LHP治疗患者7、28 d生存率均明显低于MHP、HHP治疗(P<0.05)。HHP治疗患者的急性呼吸窘迫综合征(ARDS)发生率(28.57%)明显低于LHP、MHP治疗(55.14%、50.64%,P<0.05)。大剂量组中LHP、MHP、HHP治疗患者的7 d生存率分别为39.84%、55.56%、60.87%,28 d生存率分别为17.89%、20.00%、21.74%,LHP治疗患者的7 d生存率明显低于MHP、HHP治疗(P<0.05),LHP、MHP、HHP治疗患者28 d生存率比较差异无统计学意义(P>0.05);LHP、MHP、HHP治疗患者的急性肾损伤(AKI)、ARDS发生率比较差异无统计学意义(P>0.05)。结论对于口服量小于50 mL百草枯的患者,HHP与MHP治疗的预后明显高于LHP治疗,可明显改善患者的生存率。

Objective To investigate the effect of blood hemoperfusion(HP)intensity on the prognosis of the patients with different oral administration amounts of acute paraquat poisoning.Methods The medical record data in 612 patients with acute paraquat poisoning admitted to this hospital from September 2008 to March 2018 were retrospectively analyzed.All patients were divided into the small dose group(oral administration amount<50mL,n=376)and the large dose group(oral administration amount≥50 mL,n=236)according to their oral amount of paraquat;then the patients were further divided into the low HP intensity(LHP),middle HP intensity(MHP)and the high HP intensity(HHP)subgroups according to the received HP treatment intensity.Then clinical data were collected and analyzed.Results In the low dose group,the 7 d survival rates of the patients with LHP,MHP and HHP treatment was 77.84%,88.46%and 91.43%respectively,while the 28 d survival rates were 16.22%,42.95%and 42.86%,respectively.Both the 7 d and 28 d survival rates in the LHP group were significantly lower than those in the MHP and HHP groups(P<0.05).The incidence of acute respiratory distress syndrome(ARDS)in the HHP patients(28.57%)was significantly lower than that in the LHP and MHP treatment groups(55.14%,50.64%,P<0.05).The 7 d survival rates in the patients with LHP,MHP and HHP treatment of the large dose group were 39.84%,55.56%and 60.87%,respectively,while their 28 d survival rates were 17.89%,20.00%and 21.74%respectively.The 7 d survival rate in the patients with LHP treatment was significantly lower than that in the patients with HHP and MHP treatment(P<0.05),but the 28 d survival rate had no statistical difference among the patients with LHP,MHP and HHP treatment(P>0.05);the occurrence rates of AKI and ARDS had no statisticaldifference among the patients with LHP,MHP and HHP treatment(P>0.05).Conclusion For the patients with oral paraquat amount<50 mL,the prognosis of HHP and MHP treatment is significantly higher than that of LHP treatment,which can significantly improve the survival rate of the patients.