血液灌流并连续性肾脏替代治疗和透析滤过治疗百草枯中毒疗效研究  

Analysis of paraquat elimination by hemoperfusion combined with hemodiafiltration or continuous veno-venous hemofiltration on acute paraquat poisoning

作　　者：赵爽[1,2] 李新华[2] 范淑玲[2] 胡大勇[2] 李昌斌[2] 薛闻[2] 彭艾[1,2] 

机构地区：[1]安徽医科大学上海十院临床学院,安徽合肥230032 [2]同济大学附属上海市第十人民医院肾脏风湿科,上海200072

出　　处：《中国实用内科杂志》2017年第7期621-625,共5页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金(81671897;81270136)

摘　　要：目的探索血液灌流联合血液透析滤过(HP+HDF)和血液灌流联合连续性静脉-静脉血液滤过(HP+CVVH)对百草枯中毒患者百草枯(PQ)的清除作用。方法选择2013年8月至2015年12月入住上海市第十人民医院肾脏科的急性PQ中毒患者16例,分成HP+HDF组(7例)和HP+CVVH组(9例),观察两种透析模式对中毒患者血、尿PQ浓度的影响及其与临床生化指标的关系。结果 (1)两种模式的透析器均可显著降低PQ浓度(P<0.01);(2)HP+HDF组透析器对中毒患者血液PQ的摄取率、清除率均显著高于HP+CVVH组(P<0.05);(3)HP+HDF组患者血液PQ浓度在透析开始2 h内逐渐降低,但2 h后3例患者PQ浓度再次升高,而HP+CVVH组患者在透析12 h内显著下降,之后维持在较低水平;(4)透析后HP+CVVH组血中PQ浓度较透析前显著降低(P<0.01),HP+HDF组则降低不明显(P>0.05);两组透析后尿中PQ浓度均较透析前显著降低(P<0.01);透析前后血液及尿液中PQ浓度下降百分率HP+CVVH模式均显著高于HP+HDF(P<0.01);(5)HP+CVVH组患者第7天的丙氨酸氨基转移酶、天冬氨酸氨基转移酶、血肌酐、尿素氮与第3天相比显著降低(P<0.05),HP+HDF组则无明显变化(P>0.05)。结论两种透析模式均能有效清除中毒患者血、尿中的PQ,但HP+CVVH透析模式更加高效平稳,避免了透析中血液PQ浓度的再次增高。研究为HP+CVVH和HP+HDF技术应用于百草枯中毒抢救提供了临床实验依据。Objective To explore the paraquat（PQ） elimination by combining two blood purification methods, HP＋HDF and HP＋CVVH, in acute PQ_poisoning. Method Sixteen patients with acute pQ.poisoning were enrolled in this research, who were treated from August 2013 to December 2015 in Shanghai Tenth People＇s Hospital. The patients were divided into I-IP＋HDF group （n=7） and HP＋CVVH group （n=9）. The concentrations of PQin serum and urine samples were compared between the two groups. The liver and kidney functions at 3 days and 7 days were also compared. Results （1）The serum level of PQwas significantly decreased in both groups （P〈0.01）. （2）The extraction rate and clearance rate of PQin HP＋HDF group were higher than that of HP＋CVVH group （P〈0.05）. （3）In the HP＋HDF group, the serum concentration ofPQ was reduced in the first 2 hours, but serum concentration ofPQ in 3 patients was elevated. On the contrary, in the HP＋CVVH group, the serum concentration of PQ.was reduced in the first 12 hours, and maintained at low level till the end of the blood purification. （4）After the blood purification, the serum concentration ofPQ was reduced significantly in the HP＋CVVH group（P〈O.01）, but not in the HP＋HDF group （P〉0.05）; the PQ concentration of urine was reduced significantly in both groups; PQ reduction percentage of both serum and urine in HP＋CVVH group was higher than that in HP＋HDF group （P〈0.01）. （5）The serum level ofALT, AST, SCr and BUN in HP＋CVVH group on 7th day was lower than on 3rd day（P〈0.0S）. Conclusion Both blood purification methods can eliminate PQfrom blood, and reduce PQ concentration of urine; the HP＋CVVH method can eliminate PQ more efficiently and smoothly, avoiding its rebound. The present study provids detailed data for the treatment of acute PQ_poisoning using HP＋HDF and HP＋CVVH technologies.

关 键 词：百草枯中毒 血液灌流 血液透析滤过 连续性静脉-静脉血液滤过 

分 类 号：R595.4[医药卫生—内科学]