连续性静脉-静脉血液滤过联合血液灌流对急性百草枯中毒患者血药浓度及疗效的影响  

Effect of continuous veno - venous hemofiltration combined with hemoperfusion on serum concentration and efficacy of paraquat poisoning patients

作　　者：邹宪宝[1] 孙宝泉[1] 刘颖 于中锴[1] 曲爱君[1] Zou Xian-bao;Sun Bao-quan;Liu Ying;Yu Zhong-kai;Qu Ai-jun(Department of Emergency,Liaocheng People＇s Hospital,Liaocheng 252000,China)

机构地区：[1]聊城市人民医院急诊科,山东聊城252000 [2]聊城市人民医院中西医儿科实验室,山东聊城252000

出　　处：《中国急救医学》2018年第10期890-893,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨连续性静脉-静脉血液滤过（continuous venovenous hemodiafiltration，CVVHDF）联合血液灌流（hemoperfusion，HP）对急性百草枯中毒患者血药浓度及临床疗效的影响。方法68例急性百草枯中毒患者随机分成HP组（36例）和CVVHDF＋HP组（32例），记录两组患者治疗前及治疗后24h体内百草枯浓度，比较两组患者百草枯24h清除率，治疗前及治疗后24、48、72h丙氨酸转氨酶（ALT）、总胆红素（TBil）、肌酐（Cr）、尿素氮（BUN）及动脉血氧分压（PaO2）以及出现多脏器功能衰竭时问、病死率和存活时间。结果CVVHDF＋HP组百草枯血药浓度下降速度更快，CVVHDF＋HP组的百草枯24h清除率高于HP组（91．56％vs．78．95％，P〈0．05）；CVVHDF＋HP组在治疗48、72h时ALT低于HP组（U／L，60．12±14．74VS．125．57±20．53；80．82±21．86VS．130．26±28．42，P均〈0．05）；CVVHDF＋HP组在治疗72h时TBil低于HP组（μmoL／L，15．64±3．93VS．28．37±4．34，P〈0．05）；CVVHDF＋HP组在治疗48、72h时Cr低于HP组（μmol／L，78．88±10．68VS．110．56±20．12；80．59±11．12vs．123．37±22．06，P均〈0．05）；CVVHDF＋HP组在治疗24、48、72h时BUN低于HP组（mmol／L，3．28±1．16VS．6．44±1．73；5．78±1．96VS．10．26±2．82；6．64±2．13VS．18．37±3．34；P均〈0．05）；CVVHDF＋HP组在治疗48、72h时Pa02高于HP组（mmHg，92．31±7．34VS．80．85±7．76；76．50±6．35VS．50．50±4．11，P均〈0．05）；CVVHDF＋HP组出现多脏器功能衰竭的时间晚于HP组（d，5．75±2．32VS．3．84±2．21，P〈0．05）；CVVHDF＋HP组中毒至死亡时间明显长于HP组（d，5．86±3．24VS．4．74±2．46，P〈0．05）；CVVHDF＋HP组病死率为59．4％（19／32），HP组病死率为55．6％（20／36），两组差异无统计学意义（x2=0．070，P=0．791）。结论CVVHDF＋HP可有效清除急性百草枯中毒患者体内的血药浓�Objective To investigate the effect of continuous veno- venous hemofihration combined with hemoperfusion on serum concentration and clinical efficacy in patients with acute paraquat poisoning. Methods 68 patients with acute paraquat poisoning were randomly divided into HP group （ n = 36 ） and CVVHDF ＋ HP group （ n = 32 ）. The concentrations of paraquat were recorded before and 24 hours after treatment in the two groups, and the 24 hours clearance rate of paraquat was compared between the two groups. Alanine aminotransferase （ALT）, total bilirubin （TBil） , creatinine （Cr）, urea nitrogen （BUN） and arterial oxygen partial pressure （PaO2） before and 24 hours after treatment were compared between the two groups. The time, mortality and survival time of multiple organ failurewere compared between the two groups. Results The plasma concentration of paraquat decreased faster in CVVHDF ＋ HP group than that in HP group. The clearance rate of paraquat 24 h in CVVHDF ＋ HP group was higher than that in HP group （91.56% vs. 78.95%, P 〈 0.05） ; ALT was lower than HP in CVVHDF＋HP group at 48 h and 72 h [（60. 12 ± 14.74）U/L vs. （125.57 ±20.53）U/L; （80.82 ± 21.86） U/L vs. （ 130.26 ± 28.42） U/L, P 〈 0.05 ] ; The total bilirubin （TBil） was lower in the CVVHDF ＋ HP group than that in the HP group at 72 h [ （ 15.64 ± 3.93） Ixmol/L vs. （28.37 ± 4.34） μmol/L, P 〈 0.05 ]. Cr was lower in the CVVHDF ＋ HP group than in the HP group at 48 h and 72 h [ （78.88 ± 10.68） μmol/L vs. （ 110.56 ± 20.12） μmol/L; （ 80.59 ± 11.12） μmol/L vs. （ 123. 37 ± 22.06） μmol/L, P all 〈 0.05 ]. BUN was lower in the CVVHDF ± HP group than in the HP group at 24 h, 48 h, and 72 h [ （3.28 ± 1.16） mmol/L vs. （6.44 ± 1.73 ） mmol/L ; （5.78 ± 1.96） mmol/L vs. （10.26±2.82）mmol/L; （6.64 ±2.13）mmol/Lvs. （18.37±3.34）mmol/L; Pall 〈0.05]. The arterial oxygen partial pressure （ PaO2 ） was higher in the CVVHDF ＋ HP group than that

关 键 词：急性百草枯中毒 血液灌流 血液滤过 血药浓度 临床疗效 

分 类 号：R692.5[医药卫生—泌尿科学]