江苏省908例体外血液净化治疗急性中毒: 一项横断面、多中心的真实世界研究  

Extracorporeal blood purification therapy for acute poisoning in Jiangsu Province,China:a crosssectional,multicenterreal-world study

作　　者：乔莉 张劲松 陈建荣[4] 刘励军[5] 耿平 孙虹[7] 杜叶平[8] 田质光 马建军[10] 杨如山 董建成[12] 秦正 吴珊珊 潘裕民 吴义刚 Qiao Li;Zhang Jinsong;Chen Jianrong;Liu Lijun;Geng Ping;Sun Hong;Du Yeping;Tian Zhiguang;Ma Jianjun;Yang Rushan;Dong Jiancheng;Qin Zheng;Wu Shanshan;Pan Yumin;Wu Yigang(Emergency and Critical Care Medicine Department,Jiangsu Province Hospital(the First Affiliated Hospital of Nanjing Medical University),Nangjing 210029,China;Quality Management Department,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;People's Hospital of Hainan Tibetan Autonomous Prefecture,Qinghai Province,Hainan Tibetan Autonomous Prefecture 813099,China;Emergency Department,Nantong First People's Hospital,Nantong 226002,China;Emergency Department,The Second Afliated Hospital of Soochow University,Suzhou 215004,China;Emergency Department,Northern Jiangsu People's Hospital,Yangzhou 225001,China;Huai'an First People's Hospital,Huai'an 223300,China;Emergency Department,Huai'an Second People's Hospital,Huai'an 223002,China;Third People's Hospital of Xuzhou,Xuzhou 221005,China;Nantong Fourth People's Hospital,Nantong 226002,China;The People's Hospital of Rugao,Rugao 226500,China;Institute of Digital Medicine,Nantong University,Nantong 226002,China)

机构地区：[1]南京医科大学第一附属医院急诊与危重症医学科,南京210029 [2]南京医科大学第一附属医院质量管理处,南京210029 [3]青海省海南藏族自治州人民医院,海南藏族自治州813099 [4]南通市第一人民医院急诊科,南通226002 [5]苏州大学附属第二医院急诊科,苏州215004 [6]苏北人民医院急诊科,扬州1225001 [7]淮安市第一人民医院急诊科,223300 [8]淮安市第二人民医院急诊科,淮安223202 [9]徐州市第三人民医院,221005 [10]南通市第四人民医院,南通226002 [11]如皋市人民医院,如皋226500 [12]南通大学数字医学研究所,南通226002

出　　处：《中华急诊医学杂志》2025年第3期369-375,共7页Chinese Journal of Emergency Medicine

摘　　要：目的 了解江苏省内血液净化在急性中毒救治中的使用现状。方法 这是一项多中心、横断面、真实世界的观察性研究。研究对象为2015年6月至2019年5月在江苏省的9家医院急诊科就诊的中毒患者进行观察随访,记录了患者人口统计学特征,急诊就诊后第1个小时的生命体征、治疗措施以及患者住院时间和生存情况。采用Wilcoxon秩和检验和卡方检验对接受体外血液净化治疗和未接受体外血液净化治疗的两组患者的临床数据进行了比较。结果 共纳人4178例中毒患者。其中21.7%(908/4178)的中毒患者接受了血液净化,78.3%(3270/4178)的患者未接受血液净化。血液灌流(90.4%)最常见,其次是连续肾脏替代疗法(4.4%)。在两种或两种以上的混合血液纯化模式中,4.8%接受血灌注联合连续肾脏替代疗法,0.1%接受血灌注联合血浆置换,0.1%接受血灌注联合连续肾脏替代疗法和血浆置换。在接受血液净化治疗的患者中,农药中毒(76.3%)最多见,最常见农药依次为百草枯(23.7%)敌敌畏(8.7%)、甲胺磷(5.2%)乐果(4.0%)和草甘麟(3.7%)。与非血液净化组相比,血液净化组人院第1小时内低GCS评分(3~8)患者更多(22.6%vs.9.7%,P<0.05),低平均动脉压患者更多(8.0%vs.3.2%,P<0.05),住院时间更长[5(3,9)dvs.2(1,4)d,P<0.05],病死率更高(21.1%vs.5.3%,P<0.05)。出院后28d通过电话随访,血液净化组的存活率为78.9%,病死率为21.1%。结论 血液灌流是江苏省治疗中毒最常用的血液净化方法,农药是最常见的应用血液灌流治疗的毒物。ObjectiveTo investigate the current application of blood purification in the treatment of acute poisoning within Jiangsu Province and to evaluate the impact of extracorporeal blood purification on the clinical outcomes of critically poisoned patients.Methods This multicenter,cross-sectional realworld observational study followed patients presenting with poisoning to the emergency departments of nine hospitals in Jiangsu Province between June 2015 and May 2019.Data were collected on demographic characteristics,vital signs within the first hour of emergency presentation,treatment modalities,length of hospital stay,and survival outcomes.Clinical data from patients who underwent extracorporeal blood purification were compared with those who did not,using the Wilcoxon rank-sum test and Chi-square test.Results A total of 4178 poisoning cases were included between June 2015 and May 2019.Among them,21.7%(908/4178)received blood purification therapy,while 78.3%(3270/4178)did not.Hemoperfusion(90.4%)was the most frequently employed method,followed by continuous renal replacement therapy(CRRT)(4.4%).In combined blood purification modalities,4.8%underwent hemoperfusion combined with CRRT,0.1%received hemoperfusion with plasma exchange,and another 0.1%underwent hemoperfusion combined with both CRRT and plasma exchange.Among patients who underwent blood purification,pesticide poisoning was the most prevalent(76.3%),with the most common toxic agents being paraquat(23.7%),dichlorvos(8.7%),methamidophos(5.2%),omethoate(4.0%),and glyphosate(3.7%).Compared to the non-blood purification group,patients in the blood purification group were more likely to present within the first hour with a low Glasgow Coma Scale(GCS)score(3-8)(22.6%vs.9.7%,P<0.05),low mean arterial pressure(8.0%vs.3.2%,P<0.05),longer hospital stays[5(3,9)days vs.2(1,4)days,P<0.05]and a higher in-hospital mortality rate(21.1%vs.5.3%,P<0.05).Follow-up via telephone 28 days after discharge revealed a survival rate of 78.9%,with a mortality rate of 21.1%in the blood puri

关 键 词：急性中毒 血液净化 连续肾脏替代治疗 血液灌流 病死率 住院时间 

分 类 号：R47[医药卫生—护理学]