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目的探讨连续静脉滤过(continuous venovenous hemofil-tration,CVVH)联合血液灌流(hemoperfusion,HP)治疗百草枯中毒致肺纤维化的疗效观察。方法 2014年10月—2016年10月选取本院百草枯中毒患者93例作为研究对象,随机分为观察组32例,环孢素组30例,对照组31例。所有患者在基础治疗的基础上进行治疗,对照组:甲强龙15 mg/kg,1次/d,连续3 d,7.5 mg/kg,1次/d,连续2 d,3.75 mg/kg,1次/d,连续2 d。环孢素组:在对照组基础上应用环孢素A 5 mg/kg,持续静脉泵入8 h,7.5 mg/kg,持续静脉泵入36 h。观察组在环孢素组基础上应用CVVH联合HP治疗12 h,连续5 d。比较三组低氧血症、急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)、多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)情况,并进行疗效评价。比较三组血清超氧化物歧化酶(superoxide orgotein dismutase,SOD)、丙二醛(malonic dialdehyde,MDA)含量。计量资料采用方差分析,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果观察组在<7 d低氧血症、总计低氧血症、发生ARDS、发生MODS的发生率明显低于环孢素组和对照组(18.75%、37.25%、25.00%、34.38%、43.33%、60.00%、50.00%、60.00%、48.39%、70.97%、54.84%、61.29%),观察组总有效率高于环孢素组和对照组(90.63%、70.00%、61.29%),对比差异均有统计学意义(均P<0.05)。治疗48 h,观察组SOD明显高于环孢素组和对照组,观察组MDA明显低于环孢素组和对照组,对比差异均有统计学意义(均P<0.05)。结论 CVVH联合HP治疗百草枯中毒致肺纤维化,能明显减少低氧血症、ARDS和MODS的发生,有效提高治疗的总有效率,减少肺组织纤维化的发生。治疗中未出现严重的不良反应,临床效果显著,值得临床推广。
Objective To investigate the curative effect of continuous venovenous hemofilction (CVVH) combined with hemoperfusion (HP) on pulmonary fibrosis induced by paraquat poisoning. Methods A total of 93 patients with paraquat poisoning in our hospital from October 2014 to October 2016 were randomly divided into observation group (32 cases), cyclosporine group (30 cases) and control group (31 cases). All patients were treated on the basis of basic treatment. The control group was treated with methylprednisolone 15 mg / kg once a day for 3 days, 7.5 mg / kg once a day for 2 d, 3.75 mg / kg, 1 time / d for 2 days. Cyclosporine group: The control group based on the application of cyclosporin A 5 mg / kg, continuous intravenous infusion of 8 h, 7.5 mg / kg, continuous intravenous infusion of 36 h. The observation group was treated with CVVH plus HP for 12 hours on the basis of cyclosporine for 5 days. Three groups of hypoxemia, acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome (MODS) were compared and their therapeutic effects were evaluated. The levels of serum superoxide dismutase (SOD) and malonic dialdehyde (MDA) in the three groups were compared. Measurement data using analysis of variance, count data using χ2 test, P <0.05 for the difference was statistically significant. Results The incidence of MODS in hypoxemia group was significantly lower than that of cyclosporin group and control group (18.75%, 37.25%, 25.00%, 34.38%, 43.33 60.00%, 48.39%, 70.97%, 54.84%, 61.29%). The total effective rate in observation group was higher than that in cyclosporine group and control group (90.63%, 70.00%, 61.29%) The differences were statistically significant (all P <0.05). After treatment for 48 h, the SOD in the observation group was significantly higher than that in the cyclosporine group and the control group. The MDA level in the observation group was significantly lower than that in the cyclosporine group and the control group (all P <0.05). Conclusion CVVH combined with HP treatment of paraquat poisoning induced pulmonary fibrosis, can significantly reduce the incidence of hypoxemia, ARDS and MODS, effectively improve the total effective rate of treatment and reduce the occurrence of pulmonary fibrosis. No serious adverse reactions in treatment, the clinical effect is significant, it is worth clinical promotion.