持续血液灌流对敌草快中毒患者的影响及意义  

Effects and significance of continuous hemoperfusion on patients with diquat poisoning

作　　者：王维展 刘倩 徐文嫔 刘铁镇 朱保月 齐洪娜 肖青勉 王璞 李雅琴 Wang Weizhan;Liu Qian;Xu Wenpin;Liu Tiezhen;Zhu Baoyue;Qi Hongna;Xiao Qingmian;Wang Pu;Li Yaqin(Department of Emergency,Harrison International Peace Hospital Affiliated to Hebei Medical University,Hengshui 053000,Hebei,China)

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

出　　处：《中华危重病急救医学》2022年第12期1320-1324,共5页Chinese Critical Care Medicine

基　　金：河北省卫生健康委员会科学技术研究与发展计划项目(20200404)。

摘　　要：目的探讨持续血液灌流(HP)对敌草快(DQ)中毒患者可溶性CD14亚型(sCD14-st)和中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平的影响及其意义。方法选择河北医科大学附属哈励逊国际和平医院急救医学部2018年5月至2021年8月收入院的急性DQ中毒患者86例, 按随机数字表法分为间断HP组(40例)和持续HP组(46例)。所有患者入院后均给予基础治疗, 24 h内均给予持续静脉-静脉血液滤过(CVVH)治疗;间断HP组在此基础上于2 h内行HP治疗, 每次持续2 h, 8 h 1次, 连续3次;持续HP组在此基础上行持续HP治疗, 直至尿液中无DQ成分。所有患者均在治疗前及治疗3、12、24 h及2、3、5、7 d检测血清NGAL水平, 同时在治疗前及治疗24 h、3 d、7 d检测血清sCD14-st、血乳酸(Lac)、动脉血氧分压(PaO2)、血肌酐(SCr)、肌酸激酶同工酶(CK-MB)和白细胞介素-18(IL-18)水平。绘制Kaplan-Meier生存曲线, 分析两组患者28 d生存结局。结果治疗前, 两组患者血清NGAL、sCD14-st、Lac、PaO2、SCr、CK-MB及IL-18水平比较差异均无统计学意义。随治疗时间延长, 间断HP组患者血清NGAL、sCD14-st、Lac、SCr、CK-MB和IL-18水平均呈先升高后降低趋势, 血清NGAL、sCD14-st、CK-MB和IL-18水平均于治疗24 h时达峰值, Lac和SCr水平均于治疗3 d时达峰值, 且持续HP组治疗各时间点上述指标水平均明显低于间断HP组〔治疗24 h:NGAL(μg/L)为345.90±30.75比404.24±38.79, sCD14-st(ng/L)为1 941.88±298.02比2 656.35±347.93, CK-MB(U/L)为30.67±9.11比43.28±8.06, IL-18(ng/L)为139.49±16.29比177.98±27.85;治疗3 d:Lac(mmol/L)为2.98±0.26比3.72±0.49, SCr(μmol/L)为125.01±24.24比156.74±28.88;均P<0.05〕;但两组间治疗各时间点PaO2水平比较差异均无统计学意义。Kaplan-Meier生存曲线显示, 持续HP组患者28 d病死率明显低于间断HP组〔26.09%(12/46)比52.50%(21/40);Log-Rank检验:χ2=7.288, P=0.007〕。结论持续HP治疗能有效降低DQ中毒患者的血清sObjective To investigate the effect of continuous hemoperfusion(HP)on the levels of soluble CD14 isoform(sCD14-st)and neutrophil gelatinase-associated lipocalin(NGAL)on patients with diquat(DQ)poisoning and its significance.Methods A total of 86 patients with acute DQ poisoning admitted to the department of emergency medicine,Harrison International Peace Hospital Affiliated to Hebei Medical University from May 2018 to August 2021 were enrolled and divided into the intermittent HP group(40 cases)and the continuous HP group(46 cases)according to the random number table method.All patients received basic treatment and continuous veno-venous hemofiltration(CVVH)within 24 hours after admission.On this basis,the intermittent HP group received HP treatment within 2 hours,lasting 2 hours each time for every 8 hours,3 times in all;the continuous HP group received continued HP treatment until there was no DQ component in urine samples.Serum NGAL levels were detected in all patients before treatment and at 3 hours,12 hours,24 hours,2 days,3 days,5 days,and 7 days after treatment.At the same time,serum sCD14-st,blood lactate(Lac),arterial partial pressure of oxygen(PaO2),serum creatinine(SCr),MB isoenzyme of creatine kinase(CK-MB)and interleukin-18(IL-18)levels were detected before treatment and at 24 hours,3 days,and 7 days after treatment.Kaplan-Meier survival curve was drawn to analyze the 28-day survival of patients.Results Before treatment,there was no significant difference in serum NGAL,sCD14-st,Lac,PaO2,SCr,CK-MB and IL-18 levels between the two groups.With the prolongation of treatment,the serum levels of NGAL,sCD14-st,Lac,SCr,CK-MB and IL-18 in the intermittent HP group increased at first and then decreased.Serum levels of NGAL,sCD14-st,CK-MB and IL-18 reached their peaks at 24 hours after treatment,and the Lac and SCr levels reached their peaks at 3 days after treatment.In addition,the levels of the above indexes at each time point in the continuous HP group were all significantly lower than those in the intermitt

关 键 词：急性敌草快中毒 可溶性CD14亚型 中性粒细胞明胶酶相关脂质运载蛋白 白细胞介素-18 持续静脉-静脉血液滤过 血液灌流 

分 类 号：R595.4[医药卫生—内科学]