天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (12): 1312-1315.doi: 10.11958/20170696

• 临床研究 • 上一篇    下一篇

血浆吸附灌流联合血液滤过对急性百草枯中毒 肺损伤的疗效及预后推断

陈献， 吴雨径， 杜海科△   

  1. 目的 通过观察对比血浆吸附灌流 （PP） 联合连续性静-静脉血液滤过 （CVVH） 对不同程度百草枯中毒导 致急性肺损伤（ALI）的治疗效果， 评估该方法治疗百草枯中毒的临床价值。方法 回顾性分析 2013 年 6 月—2017 年 4 月于我院住院治疗的百草枯中毒患者 197 例， 其中轻中度中毒 ［5 mg·h/L≤中毒严重指数 （SIPP） ≤25 mg·h/L］ 128 例， 重度中毒（25 mg·h/L＜SIPP≤50 mg·h/L） 69 例， 根据是否进行 PP 及 CVVH 联合治疗分为治疗组和对照组， 对 2 组患者不可逆肺损伤的发生率及出现时间进行比较。结果 （1） 在轻中度中毒患者， 治疗组肺损伤的发生率明显低 于对照组（P＜0.05）； 在重度中毒患者， 治疗组和对照组肺损伤的发生率差异无统计学意义（P＞0.05）。（2）不同中毒 程度 2 组患者不可逆肺损伤出现时间差异均无统计学意义（P＞0.05）。（3）可把血毒物浓度 4.35 mg·h/L、 SIPP 值 19.35 mg·h/L 作为治疗组判断预后的临界指标。结论 采用 PP 联合 CVVH 治疗能够明显减少轻中度百草枯中毒 肺损害的发生率， 但对其发生时间无明显影响。
  • 收稿日期:2017-06-14 修回日期:2017-10-03 出版日期:2017-12-15 发布日期:2017-12-15
  • 通讯作者: 杜海科 E-mail:duhaike@163.com

Clinical value and inference prognosis of plasma perfusion combined with hemofiltration in the treatment of acute paraquat poisoning lung injury and prognosis

CHEN Xian, WU Yu-jing, DU Hai-ke△   

  1. Objective To observe the curative effect of plasma perfusion (PP) combined with continuous veno-venous hemofiltration (CVVH) on different degrees of paraquat poisoning induced acute lung injury (ALI), and assess its clinical value for treatment of paraquat poisoning. Methods Data of 197 patients with paraquat poisoning hospitalized in our hospital from June 2013 to April 2017 were retrospectively analysed, including 128 cases with mild-to-moderate poisoning (5 mg·h/L≤SIPP≤25 mg·h/L) and 69 cases with severe poisoning (25 mg·h/L＜SIPP≤50 mg·h/L). Patients were divided into treatment group and control group according to the treatment of PP and CVVH. The incidence rate and time of irreversible lung injury were compared between the two groups of patients. Results (1) In patients with mild-to-moderate poisoning, the incidence rate of lung injury was significantly lower in treatment group than that of control group (P < 0.05). In patients with severe poisoning there was no significant difference in the incidence rate of lung injury between two groups (P > 0.05). (2) There was no significant difference in the occurrence time of irreversible lung injury between two groups of patients with different degrees of poisoning (P > 0.05). (3) The blood toxicant concentration of 4.35 mg·h/L and SIPP value 19.35 mg·h/L were used as a critical indicator of prognosis in treatment group. Conclusion Plasma perfusion combined with continuous veno-venous hemofiltration can obviously reduce the incidence of paraquat poisoning of lung injury in mild-to-moderate patients, but which has no obvious influence on the occurrence time.
  • Received:2017-06-14 Revised:2017-10-03 Published:2017-12-15 Online:2017-12-15

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摘要： 目的 通过观察对比血浆吸附灌流 （PP） 联合连续性静-静脉血液滤过 （CVVH） 对不同程度百草枯中毒导 致急性肺损伤（ALI）的治疗效果， 评估该方法治疗百草枯中毒的临床价值。方法 回顾性分析 2013 年 6 月—2017 年 4 月于我院住院治疗的百草枯中毒患者 197 例， 其中轻中度中毒 ［5 mg·h/L≤中毒严重指数 （SIPP） ≤25 mg·h/L］ 128 例， 重度中毒（25 mg·h/L＜SIPP≤50 mg·h/L） 69 例， 根据是否进行 PP 及 CVVH 联合治疗分为治疗组和对照组， 对 2 组患者不可逆肺损伤的发生率及出现时间进行比较。结果 （1） 在轻中度中毒患者， 治疗组肺损伤的发生率明显低 于对照组（P＜0.05）； 在重度中毒患者， 治疗组和对照组肺损伤的发生率差异无统计学意义（P＞0.05）。（2）不同中毒 程度 2 组患者不可逆肺损伤出现时间差异均无统计学意义（P＞0.05）。（3）可把血毒物浓度 4.35 mg·h/L、 SIPP 值 19.35 mg·h/L 作为治疗组判断预后的临界指标。结论 采用 PP 联合 CVVH 治疗能够明显减少轻中度百草枯中毒 肺损害的发生率， 但对其发生时间无明显影响。

关键词: 百草枯, 中毒, 血浆灌流, 血液滤过, 急性肺损伤

Abstract: Objective To observe the curative effect of plasma perfusion (PP) combined with continuous veno-venous hemofiltration (CVVH) on different degrees of paraquat poisoning induced acute lung injury (ALI), and assess its clinical value for treatment of paraquat poisoning. Methods Data of 197 patients with paraquat poisoning hospitalized in our hospital from June 2013 to April 2017 were retrospectively analysed, including 128 cases with mild-to-moderate poisoning (5 mg·h/L≤SIPP≤25 mg·h/L) and 69 cases with severe poisoning (25 mg·h/L＜SIPP≤50 mg·h/L). Patients were divided into treatment group and control group according to the treatment of PP and CVVH. The incidence rate and time of irreversible lung injury were compared between the two groups of patients. Results (1) In patients with mild-to-moderate poisoning, the incidence rate of lung injury was significantly lower in treatment group than that of control group (P < 0.05). In patients with severe poisoning there was no significant difference in the incidence rate of lung injury between two groups (P > 0.05). (2) There was no significant difference in the occurrence time of irreversible lung injury between two groups of patients with different degrees of poisoning (P > 0.05). (3) The blood toxicant concentration of 4.35 mg·h/L and SIPP value 19.35 mg·h/L were used as a critical indicator of prognosis in treatment group. Conclusion Plasma perfusion combined with continuous veno-venous hemofiltration can obviously reduce the incidence of paraquat poisoning of lung injury in mild-to-moderate patients, but which has no obvious influence on the occurrence time.

Key words: paraquat, poisoning, plasma perfusion, hemofiltration, acute lung injury