不同方式血液净化治疗百草枯中毒的比较  

Comparative study of different methods of blood purification treatment of paraquat intoxication

作　　者：周亚东[1] 史继学[1] 杨琳[1] 汤庆宾[1] 程岳雷[1] 张宪静[1] 

机构地区：[1]泰山医学院附属医院急诊医学科山东省临床中毒救治研究所,泰安271000

出　　处：《中华劳动卫生职业病杂志》2014年第11期862-864,共3页Chinese Journal of Industrial Hygiene and Occupational Diseases

摘　　要：目的 研究血液灌流（HP）、血液灌流联合血液透析（HP＋HD）、血液灌流联合持续静脉-静脉血液滤过（HP＋CVVH）对百草枯中毒患者毒物清除作用.方法 选取本院收治的72例百草枯中毒患者,在给予常规药物治疗的同时分别给予HP、HP＋HD、HP＋CVVH 3种血液净化方式,对比观察血液净化前后血百草枯浓度下降率、肝肾功能损害和患者死亡率.结果 HP＋HD、HP＋CVVH组百草枯浓度下降率明显大于HP组,差异有统计学意义（P＜0.05）,HP＋HD、HP＋CVVH组百草枯浓度下降率的差异无统计学意义（P＞0.05）.HP＋HD组和HP＋CVVH组天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）升高率均明显低于HP组,差异有统计学意义（P＜0.05）,HP＋HD组和HP＋CVVH组AST、ALT升高率的差异无统计学意义（P＞0.05）.HP＋HD组Cr升高率（223％±19.9％）均明显低于HP组（445％±37.6％）和HP＋CVVH组（289％±20.7％）,差异有统计学意义（P＜0.05）,HP＋CVVH组和HP组Cr升高率差异有统计学意义（P＜0.05）.HP组、HP＋HD组、HP＋CVVH组BUN升高率分别为323％±25.7％、192％±15.6％、223％±19.7％,其中HP＋HD组及HP＋CVVH组BUN升高率均明显低于HP组,差异有统计学意义（P＜0.05）,HP＋HD组与HP＋CVVH组的差异无统计学意义（P＞0.05）.HP＋HD、HP＋CVVH组存活时间均较HP组延长,差异有统计学意义（P＜0.05）.3组患者死亡率无明显差异.结论 3种血液净化方式均可有效清除吸收入血的毒物,HP＋HD或HP＋CVVH可有效降低肝肾功能损害程度,延长存活时间,但不能明显提高患者存活率.Objective To investigate the different effect of three methods of blood purification for paraquat poisoning patients：hemoperfusion （HP）,hemoperfusion combined with hemodialysis （HP ＋ HD）,hemoperfusion combined with continuous veno-venous hemofiltration （HP ＋ CVVH）.Methods：72 cases of paraquat poisoning patients were divided into three groups after giving conventional therapy HP group,HP ＋ HD group,HP ＋ CVVH group.Compared the rate of decline concentrations of paraquat in blood,the liver and the kidney damage between before and after blood purification and contrast the mortality in three groups after different method of blood purification.Results：The rate of decline concentrations of paraquat in blood of the HP ＋ HD group and HP ＋ CVVH group were both significantly greater than the HP group,but this result of HP ＋ HD group has no significant difference compared with HP ＋ CVVH group; Among the three groups of patients after 72 hours,the degree of dysfunction of liver of the HP ＋ HD group and HP ＋ CVVH group were both significantly lower than the HP group,whilely the degree of dysfunction of kidney of the HP ＋ HD group was significantly lower than the HP group and the HP ＋ CVVH group.The survival time of the HP ＋ HD group and the HP ＋ CVVH group were significant linger than the HP group,but the comparison among the three groups had no significant difference in mortality.Conclusion：Three blood purification methods can effectively remove paraquat absorbed into the blood,and the hemoperfusion combined with hemodialysis or continuous venovenous hemofiltration can effectively reduce the degree of damage of liver and kidney and also can prolong survival time,but did not significantly improve the survival rate of patients.

关 键 词：百草枯 中毒 血液 灌流 

分 类 号：R595.4[医药卫生—内科学]