血液透析联合血液灌流和甲泼尼龙冲击治疗百草枯中毒观察  

Study on combined hemodialysis with hemoperfusion and methylprednisolone in treatment of paraquat poisoning

作　　者：刘振坤[1] 纪志伟[1] 张玉波[1] 袁亚松 陈立敏[3] 

机构地区：[1]涿州市医院急诊科,河北涿州072750 [2]涿州市医院重症监护室,河北涿州072750 [3]涿州市医院消化内科,河北涿州072750

出　　处：《临床和实验医学杂志》2015年第6期502-504,共3页Journal of Clinical and Experimental Medicine

摘　　要：目的探讨血液透析联合血液灌流和甲泼尼龙冲击治疗百草枯中毒的临床效果。方法将收治的60例百草枯中毒患者随机分为研究组和对照组,每组30例。对照组患者给予常规血液透析和甲泼尼龙冲击治疗。研究组在此基础上加用血液灌流治疗。比较两组患者多脏器功能衰竭发生率和病死率、不同时间点白细胞介素10(IL-10)和肿瘤坏死因子α(TNF-α)水平变化、肌酸激酶同工酶(CK-MB)、丙氨酸氨基转移酶(ALT)、血肌酐(Scr)、血浆CO2、血淀粉酶(AMY)和白细胞计数(WBC)峰值。结果研究组患者多脏器功能衰竭和病死率显著低于对照组(P<0.05)。研究组患者首次治疗后0 h、3 d和7 d的IL-10和TNF-α水平显著低于对照组(P<0.01)。研究组患者CK-MB、ALT、血浆CO2和WBC峰值与对照组存在显著差异(P<0.05)。研究组Scr和AMY的峰值与对照组无显著差异(P>0.05)。结论血液滤过联合血液灌流和甲泼尼龙冲击治疗百草枯中毒可以显著降低患者炎症反应、肝损伤和酸性中度,进而降低患者多脏器功能衰竭发生率和病死率。Objective To explore the clinical effect of combined hemodialysis with hemoperfusion flow and methylprednisolone in treatment of patients with paraquat poisoning. Methods A total of 60 patients with paraquat poisoning were randomly divided into study group and control group,30 cases in each group. Patients in control group were treated with conventional hemodialysis and methylprednisolone pulse therapy.Patients in study group were treated with hemoperfusion on the basis of treatment in control group. Patients with multiple organ failure and mortality at different time points were compared between these 2 groups. The changes in levels of IL-10 and TNF,CKMB,ALT,Scr,AMY,plasma CO2 concentration and WBC count were compared between these 2 groups. Results Patients with multiple organ failure and mortality in study group were significantly lower than those of control group（ P 0. 05）. Levels of IL-10 and TNF in study group at 0 h,3 d and 7 d were significantly lower than those of control group（ P 0. 01）. There was significant difference in levels of CKMB,ALT,plasma CO2 and WBC peak between patients of study group and control group（ P 0. 05）. The difference in level of Scr and the peak of AMY between study group and control group was not significant（ P 0. 05）. Conclusion Hemofiltration combined hemoperfusion and methylprednisolone in treatment of patients with paraquat poisoning can significantly reduce inflammatory reaction,liver damage and acidic medium,thus it can reduce the occurrence of multiple organ failure and mortality.

关 键 词：百草枯中度 血液滤过 血液灌流 甲泼尼龙 

分 类 号：R595.4[医药卫生—内科学]