血液灌流治疗急性中毒患者并发出血的危险因素分析

Analysis of risk factors for hemorrhage in patients with acute poisoning treated with hemoperfusion

目的探讨急性中毒患者血液灌流治疗并发出血的临床特点和危险因素。方法于2021年1月,分析2018年1月至2020年12月在空军军医大学第二附属医院行血液灌流治疗的196例急性中毒患者的临床资料,根据患者是否并发出血分为出血组与未出血组。应用logistic回归分析血液灌流治疗患者并发出血的危险因素。结果共纳入出血组患者21例,未出血组175例;两组患者的性别、年龄、体重指数等一般资料差异均无统计学意义(P>0.05)。有机磷农药(χ2=4.56,P=0.030)、HA230灌流器(χ2=4.12,P=0.042)、灌流2 h血小板计数(t=-2.33,P=0.009)和活化部分凝血活酶时间(t=14.53,P<0.001)等是血液灌流治疗急性中毒患者并发出血的影响因素;其中,有机磷农药和灌流2 h活化部分凝血活酶时间≥35 s等是并发出血的独立危险因素(P<0.05)。结论急性中毒尤其是有机磷农药中毒患者在血液灌流治疗中发生出血的风险较大,应加强监测活化部分凝血活酶时间变化以及时调整抗凝药物剂量,降低出血风险。

Objective To explore the clinical characterist ics and risk factors of hemorrhage complicated by hemoperfusion therapy in patients with acute poisoning.Methods In January 2021,the clinical data of 196 patients with acute poisoning who received hemoperfusion therapy in the Second Affiliated Hospital of Air Force Military Medical University from January 2018 to December 2020 were analyzed,and the patients were divided into bleeding group and non-bleeding group according to whether the patients were complicated with bleeding.Multivariate logistic regression was used to analyze the independent risk factors for hemorrhage in patients treated with hemoperfusion.Results A total of 21 patients in the bleeding group and 175 patients in the non-bleeding group were included.There was no significant difference in general data such as gender,age,and body mass index between the two groups(P>0.05).Organophosphorus pesticides(χ2=4.56,P=0.030),HA230 perfusion device(χ2=4.12,P=0.042),platelet count(t=-2.33,P=0.009)and activated partial thromboplastin time(t=14.53,P<0.001)at 2 h of perfusion were the influencing factors of hemorrhage in patients with acute poisoning treated with hemoperfusion.Among them,organophosphorus pesticides,2 h perfusion activated partial thromboplastin time≥35 s and other factors were independent risk factors forcomplicated bleeding(P<0.05).Conclusion Patients with acute poisoning,especially organophosphorus pesticide poisoning,are at greater risk of bleeding during hemoperfusion therapy.Monitoring of changes in activated partial thromboplastin time should be strengthened and the dose of anticoagulants should be adjusted in time to reduce the risk of bleeding.