血液净化对急性虫螨腈中毒的清除效果评价

Effect of hemopurification on acute chlorfenapyr poisoning

目的依据血药浓度评估血液净化技术对急性虫螨腈中毒的治疗效果,为临床救治提供经验。方法2022年本院收治2例进行血液净化治疗的急性虫螨腈中毒患者,动态监测血液中虫螨腈及其高毒性代谢产物溴代吡咯腈浓度,并收集患者的临床资料。结果病例1摄入13 h后给予首次血液灌流,灌流l h时溴代吡咯腈浓度下降率为28.82%,灌流2 h时回升并超过灌流前水平。完成3次血液灌流后,血液中虫螨腈、溴代吡咯腈浓度仍超过首次灌流前浓度,分别达到248 ng/mL和1307 ng/mL。摄入130 h后血虫螨腈浓度呈下降趋势,溴代吡咯腈浓度在130h达峰值3164 ng/mL,178 h下降至2707 ng/mL。病例2在摄入150 h后血液中虫螨腈、溴代吡咯腈浓度分别达到392 ng/mL和7733 ng/mL,进行四次血液灌流,首次血液灌流后血液中虫螨腈浓度下降率37.75%,溴代吡咯腈浓度下降率为38.02%。给予持续性血液透析滤过(continuous veno-venous hemodiafiltration,CVVHDF)治疗85 h,溴代吡咯腈浓度维持在4234~6410 ng/mL。预后:病例1随访至12 d后失访,未查证到死亡信息;病例2死亡,生存期为247 h。结论血液灌流仅可部分清除溴代吡咯腈,CVVHDF清除溴代吡咯腈能力差。虫螨腈和溴代吡咯腈表观分布容积(apparent volume of distribution,Vd)大,摄入后快速进入各组织,易在脂肪等组织蓄积,其后缓慢释放回血液,在血液中停留时间较长,虫螨腈的峰值浓度出现早于溴代吡咯腈。临床医生应重视早期消化道清除毒物。

Objective To evaluate the therapeutic effect of hemopurification on acute chlorfenapyr poisoning according to the blood concentration of chlorfenapyr and to provide experience for clinical treatment.Methods Two patients who presented to our Emergency Department following an ingestion of chlorfenapyr and then were treated with hemopurification in 2022 were included.The concentrations of chlorfenapyr and its highly toxic metabolite tralopyril were dynamically monitored,and the clinical data of the patients were collected.Results Case 1 was given hemoperfusion for the first time 13 hours after ingestion.During l hour hemoperfusion,the tralopyril decreased by 28.82%.The concentration increased and exceeded the pre-perfusion level after 2 hours of hemoperfusion.After three times of hemoperfusion,the concentrations of chlorfenapyr and tralopyril were still higher than those before the first time,reaching 248 ng/mL and 1307 ng/mL respectively.The concentration of chlorfenapyr showed a downward trend after 130 h,and the tralopyril in blood reached the peak 3164 ng/mL at 130 h and decreased to 2707 ng/mL at 178 h.In case 2,the blood chlorfenapyr and tralopyril concentration was 392 ng/mL and 7598 ng/mL respectively 150 hours after ingestion.The blood chlorfenapyr concentration decreased by 37.75%respectively after first hemoperfusion,and the tralopyril concentration decreased by 38.02%respectively.During 85 hours of continuous veno-venous hemodiafiltration(CVVHDF),the concentration of tralopyril was maintained at 4234~6410 ng/mL.Case 1 was followed up to 12 days and lost follow-up.Case 2 died and the survival time was 247 hours.Conclusions Hemoperfusion can scavenge tralopyril,but CVVHDF has poor scavenging ability for tralopyril.And the apparent volume of distribution(Vd)of chlorfenapyr and tralopyril are large.After ingestion,chlorfenapyr spreads to various tissues quickly,and it is easy to accumulate in the adipose tissue.The chlorfenapyr in the tissue slowly is released back to the blood and stays in the blood for a long time.The peak concentration of chlorfenapyr appeared earlier than that of tralopyril.Clinicians should pay attention to the early removal of toxins from the digestive tract.