血液净化联合乌司他丁治疗急性百草枯中毒的临床研究

Clinical study of blood purification combined with ulinastatin on the treatment of acute paraquat poisoning

目的探讨血液净化联合乌司他丁治疗急性百草枯中毒的临床疗效。方法选取我院急诊科2011年10月至2015年10月收治的急性百草枯中毒患者108例。采用随机数表法将患者分为观察组55例和对照组53例。对照组在常规对症治疗基础上进行血液灌流加血液滤过治疗,观察组在对照组治疗的基础上加用乌司他丁注射液20万U,微泵注射(2次/d),连续5~7 d。观察两组患者血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、超氧化物歧化酶(SOD)和脂质过氧化物(MDA)水平变化、并发症和疗效。结果治疗后,观察组患者血清TNF-α、IL-6、IL-10、SOD和MDA水平分别为(24.56±14.78)μg/L、(24.24±10.08)μg/L、(20.54±9.78)μg/L、(68.78±29.60)U/L和(2.58±0.99)mmol/L,对照组为(29.86±23.10)μg/L、(38.77±15.43)μg/L、(25.40±11.78)μg/L、(102.30±29.33)U/L和(3.96±1.35)mmol/L,其中TNF-α、IL-6、IL-10和MDA观察组显著高于对照组,SOD水平观察组显著低于对照组,差异均有统计学意义(P<0.05);观察组患者并发肺纤维化发生率为23.6%(13/55),明显低于对照组的37.7%(20/53),差异有统计学意义(P<0.05);观察组患者好转率为36.4%(20/55),明显高于对照组的22.6%(12/53),死亡率为40.0%(22/55),明显低于对照组的56.6%(30/53),差异均有统计学意义(P<0.05);观察组死亡患者存活时间为(10.5±5.2)d,明显长于对照组的(8.5±3.7)d,差异有统计学意义(P<0.05)。结论血液净化联合乌司他丁治疗急性百草枯中毒可有效改善患者的多脏器功能,降低死亡率,延长生存时间。

Objective To investigate the clinical curative effect of blood purification combined with ulinastatin on acute paraquat poisoning. Methods A total of 108 cases of patients with acute paraquat poisoning, who admitted to Department of Emergency of Meishan Hospital of Traditional Chinese Medicine from October 2011 to October 2015,were selected and divided into the observation group(n=55) and the control group(n=53) according to the random number method. The control group applied conventional therapy and blood perfusion and filtration treatment, and the observation group was treated with ulinastatin injection 200 000 U, micro pump injection(2 times/d) based on the control group for 5~7 d. The changes of serum TNF-α, IL-6, IL-10, SOD and MDA levels, and complications and efficacy in the two groups were observed. Results After treatment, the serum TNF-α, IL-6, IL-10 and MDA levels of observation group were(24.56±14.78) μg/L,(24.24±10.08) μg/L,(20.54±9.78) μg/L and(2.58±0.99) mmol/L, respectively which were significantly higher than those of the control group of(29.86 ±23.10) μ g/L,(38.77 ±15.43) μ g/L,(25.40 ±11.78) μ g/L and(3.96±1.35) mmol/L, respectively. SOD level(68.78±29.60) U/L in the observation group was significantly lower than that in the control group of(102.30±29.33) U/L. All the differences were statistically significant(P<0.05). The probability of pulmonary fibrosis in the observation group was 23.6%(13/55), which was significantly lower than that of the control group of 37.7%(20/53), P<0.05; the improvement rate of the observation group of 36.4%(20/55) was significantly higher than that of the control group of 22.6%(12/53), P<0.05; the mortality rate of the observers group of 40.0%(22/55) was significantly lower than that of the control group of 56.6%(30/53), P<0.05; the survival time of the patients in the observation group was(10.5±5.2) days, which was significantly longer than that of the control group of(8.5±3.7) days, P<0.05. Conclusion Acute paraquat poisoning treated with blood purification combined with ulinastatin can effectively improve multiple organ function of patients, reduce mortality, and prolong the survival time.