连续血液灌流对急性百草枯中毒患者血清白介素-18水平及预后的影响  

Clinical research of continuous hemoperfusion on the level of IL-18 and prognosis in patients with acute paraquat poisoning

作　　者：朱保月 苏晓阳 王岩 杜艳雪 王维展 齐洪娜 

机构地区：[1]河北医科大学附属哈励逊国际和平医院急救医学部,河北衡水053000 [2]衡水市第三人民医院,河北衡水053000

出　　处：《实用医学杂志》2018年第2期231-234,238,共5页The Journal of Practical Medicine

基　　金：河北省省级科技计划项目(编号:162777109D);衡水市科学技术研究与发展计划项目(编号:15023)

摘　　要：目的探讨连续血液灌流对急性百草枯中毒(APP)患者血清白介素-18(IL-18)水平及预后的影响。方法选择我院2013年6月至2017年7月收治的APP患者112例随机分成对照组和治疗组各56例,入院后对照组给予常规药物和血液灌流治疗,治疗组给予常规药物和连续血液灌流治疗,两组患者治疗24 h均给予持续静脉-静脉血液滤过。2组患者均在入院24 h内、3 d、7 d,检测IL-18、乳酸(Lac)、动脉血氧分压(Pa O_2)、丙氨酸氨基转移酶(ALT)、肌酐(Cr)和肌酸激酶同工酶(CK-MB)水平的变化,记录2组患者28 d生存情况,分析APP患者血清IL-18水平与其生存率的相关性。结果治疗前2组患者IL-18、Lac、Pa O_2、ALT、Cr和CK-MB水平比较,差异无统计学意义(P>0.05)。治疗后3 d,2组患者IL-18、Lac、ALT、Cr和CK-MB水平均较治疗前增高,治疗组低于对照组;Pa O_2较治疗前降低,治疗组高于对照组(P<0.05)。治疗后7 d,2组IL-18、Lac、ALT、Cr和CK-MB水平均较治疗后3 d降低,治疗组均低于对照组;Pa O_2较治疗后3 d降低,治疗组高于对照组(P<0.05)。治疗组死亡39例,对照组死亡49例,治疗组28 d病死率低于对照组(69.64%vs.87.50%,χ~2=5.303,P=0.021)。APP患者血IL-18水平与其生存率呈负相关(r=-0.209,P=0.027)。结论连续血液灌流对APP患者的疗效优于间断血液灌流,能降低IL-18、Lac、ALT、Cr和CK-MB水平,提高患者Pa O_2,降低病死率,取得良好疗效。Objective To investigate the clinical values of continuous hemoperfusion on the level of inter- leukin-18 （IL-18） and prognosis in patients with acute paraquat poisoning （APP）. Methods A total of 112 pa- tients with APP treated in our hospital from Jun 2013 to Jul 2017 were divided into two groups- control group （56 cases, routine drug and single hemoperfusion ） and therapy group （56 cases, treated by continuous hemoperfusion based on control group ）. All APP patients were treated with continuous veno venous hemofiltration （CVVH） at 24 hours after treatment. Within admission 24 hours, 3 days and 7 days after treatment, IL-18, lactic acid （Lac）, ar- terial oxygen partial pressure （PaO2）, alanine aminotransferase （ALT）, creatinine （Cr） and creatine kinase （CK- MB ） of patients were detected, 28-day survival was recorded. Pearson correlation test was used to analyze the corre- lation between IL-18 in patients with APP and the survival rate. Results In admission, there were no differences in the levels of IL-18, Lac, PaO2, ALT, Cr and CK-MB between the two groups （P 〉 0.05）. At 3 days after treat- ment, the levels of IL-18, Lac, ALT, Cr and CK-MB were higher than those before treatment, and the therapy group was lower than the control group, while PaO2 was lower than those before treatment, and the therapy group was higher than the control group （P 〈 0.05 ） ; At 7 days after treatment, the two groups both had lower levels of IL -18, Lac, ALT, Cr and CK-MB than those after 3 days treatment, and the therapy group was lower than the con- trol group, while PaO2 was lower than those after 3 days treatment, and the therapy group was higher than the con- trol group （P 〈 0.05） ; There were 39 deaths in the therapy group and 49 deaths in the control group, the therapy group had a lower 28-day mortality rate than control group, the difference was statistically significant （69.64% vs 87.50%, X2=5.303, P=0.021 ）. The level of serum IL-18 in patients with APP was negat

关 键 词：急性百草枯中毒 白介素-18 乳酸 持续血液灌流 持续静脉-静脉血液滤过 

分 类 号：R595.4[医药卫生—内科学]