组合式血浆成分分离吸附滤过技术在重度农药中毒救治中的应用研究  

Fractionated plasma separation and adsorption integrated with continuous veno-venous hemofiltration in patients with severepesticidepoisoning

作　　者：董建华 杨茜 吴边 黄力 李川 葛永纯 DONG Jianhua;YANG Xi;WU Bian;HUANG Li;LI Chuan;GE Yongchun(National Clinical Research Center for Kidney Diseases,Jinling Hospital,Nanjing 210016,China)

机构地区：[1]东部战区总医院国家肾脏疾病临床医学研究中心,南京210016

出　　处：《肾脏病与透析肾移植杂志》2023年第6期501-507,共7页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：江苏省自然科学基金面上项目(BK20201235)。

摘　　要：目的:观察组合式血浆成分分离吸附滤过技术(FPSA-CVVH)在重度农药中毒治疗中的临床疗效与安全性。方法:回顾性分析24例农药中毒患者,有机磷中毒6例、敌草快和百草枯中毒各9例。所有患者已经达到或超过农药中毒致死剂量,或病情分级达中~重度及以上。观察FPSA-CVVH治疗重度农药中毒患者的预后及不良反应,以及对细胞因子清除效果。结果:17例(70.8%)合并急性肾损伤,11例(45.8%)合并急性肝损伤。高迁移率族蛋白B-1(HMGB-1)、白细胞介素(IL)-6、IL-8、γ干扰素诱导蛋白10(IP-10)、单核细胞趋化蛋白1(MCP-1)和巨噬细胞炎症蛋白1β(MIP-1β)明显升高。所有患者共行56次FPSA-CVVH。单次FPSA-CVVH治疗8 h后血清HMGB-1、IL-6、IL-8、IP-10、MCP-1和MIP-1β下降率分别为64.2%、64.2%、75.5%、65.2%、56.7%和56.3%。FPSA-CVVH治疗过程中1例因血浆成分分离器凝血而更换滤器,1例出现出血不良反应。90 d患者存活率为58.3%(有机磷中毒5例、百草枯中毒4例、敌草快中毒5例),肝肾功能均恢复正常。结论:FPSA-CVVH能有效降低细胞因子水平,不良反应少,对重度农药中毒的救治成功率较高。Objective:To evaluate the clinical efficacy and safety of fractionated plasma separation and adsorption integrated with continuous veno⁃venous hemofiltration(FPSA⁃CVVH)treatment in patients with severe pesticide poisoning.Methodology:In this retrospective study,we enrolled 24 patients with pesticide poisoning(6 patients with organophosphorus pesticide poisoning,9 patients with pesticide poisoning and paraquat poisoning respectively).The pesticide poisoning dose in all patients had reached or exceeded the poisoning lethal dose,or the poisoning condition grade was moderate to severe or above.The prognosis and adverse effects of FPSA⁃CVVH treatment in patients,and the effect of FPSA⁃CVVH on cytokine clearance were observed.Results:17(708%)patients with acute kidney injury and 11(458%)with acute liver injury.The serum high mobility group protein B⁃1(HMGB⁃1),interleukin⁃6(IL⁃6),IL⁃8,interferonγ⁃inducible protein⁃10(IP⁃10),monocyte chemotactic protein 1(MCP⁃1)and macrophage inflammatory protein 1β,MIP⁃1βwere significantly increased.All patients underwent 56 sessions of FPSA⁃CVVH.After 8h of single FPSA⁃CVVH,HMGB⁃1,IL⁃6,IL⁃8,IP⁃10,MCP⁃1 and MIP⁃1βdecreased by 642%,642%,755%,652%,567%and 563%respectively.One patients had severe coagulation and their filters changed.And other patients exhibited bleeding.The survival rate of 90⁃day patients was 583%(including 5 patients with organophosphorus pesticide poisoning,4 patients with paraquat poisoning and 5 patients with pesticide poisoning),the liver and kidney functions returned to normal.Conclusion:FPSA⁃CVVH can effectively reduce the cytokines level,improve the success rate of patients with severe pesticide poisoning,and low incidence of adverse reactions.

关 键 词：农药中毒 血液净化 细胞因子 临床疗效 不良反应 

分 类 号：R595.4[医药卫生—内科学]