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目的:观察血液灌流(HP)串连不同模式连续性血液净化(CBP)治疗对急性百草枯(PQ)中毒患者临床疗效的影响。方法:采用回顾性队列研究方法,选择2008-01-2015-06由我院重症医学科收治的急性PQ中毒患者。纳入年龄≥16岁、PQ峰浓度≥0.5μg/ml、接受HP治疗且资料完整的患者,根据治疗方案将患者分为HP治疗组、HP串联连续性静-静脉血液滤过(CVVHF)治疗组和HP串联连续性静-静脉血液透析滤过(CVVHDF)治疗组。采用Cox比例风险回归模型评估3组患者死亡风险比,评价HP串联CVVHF治疗和HP串联CVVHDF治疗对急性PQ中毒患者存活率的影响;运用log-rank检验评估3种治疗方案对急性PQ中毒患者临床疗效。结果:符合研究标准的急性PQ中毒患者227例。Cox比例风险回归模型分析结果显示HP串联CVVHF治疗(HR=0.483,95%CI:0.307~0.626;P=0.008)和HP串联CVVHDF治疗(HR=0.731,95%CI:0.658~0.896;P<0.01)显著降低患者的死亡风险;HP联合CBP组患者存活率(54.1%)显著高于HP治疗组(42.6%)(P<0.05),延迟患者死亡时间(P<0.01)。HP串联CVVHF治疗组和HP串联CVVHDF治疗组患者存活率差异无统计学意义。结论:HP串联CVVHF治疗和HP串联CVVHDF治疗能改善急性PQ中毒患者的预后,效果较HP好;HP串连不同模式CBP治疗能提高急性PQ中毒患者的存活率,其可作为急性PQ中毒患者理想的治疗方案。
Objective: To observe the effect of continuous blood purification (CBP) with different modes of continuous perfusion of blood on clinical curative effect of acute paraquat poisoning. Methods: A retrospective cohort study was conducted to select patients with acute PQ poisoning who were admitted to our department of critical care from January 2008 to June 2015. The patients were enrolled in the HP treatment group and the HP series CVTH treatment group according to the treatment plan, including the patients aged ≥16 years and PQ peak concentration≥0.5μg / ml. And HP tandem continuous venovenous hemodiafiltration (CVVHDF) treatment group. Cox proportional hazards regression model was used to evaluate the risk of death among three groups of patients. The effects of HP series CVVHF and HP series CVVHDF on the survival rate of patients with acute PQ poisoning were evaluated. The log-rank test was used to evaluate the efficacy of the three treatment regimens in patients with acute PQ poisoning Efficacy. Results: A total of 227 patients with acute PQ poisoning were included in the study. Cox proportional hazard regression model analysis showed that HP series CVVHF treatment (HR = 0.483, 95% CI: 0.307-0.626; P = 0.008) and HP series CVVHDF treatment (HR = 0.731, 95% CI: 0.658-0.896; ) Significantly reduced the risk of death in patients. The survival rate of patients with HP combined with CBP (54.1%) was significantly higher than that of HP (42.6%) (P <0.05), and the death time was delayed (P <0.01). There was no significant difference in the survival rate between HP series CVVHF treatment group and HP series CVVHDF treatment group. Conclusion: HP series CVVHF treatment and HP series CVVHDF treatment can improve the prognosis of patients with acute PQ poisoning, the effect is better than HP; HP series of different modes of CBP treatment can improve the survival rate of patients with acute PQ poisoning, which can be ideal for patients with acute PQ poisoning Treatment program.