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目的探索血液灌流联合血液透析滤过(HP+HDF)和血液灌流联合连续性静脉-静脉血液滤过(HP+CVVH)对百草枯中毒患者百草枯(PQ)的清除作用。方法选择2013年8月至2015年12月入住上海市第十人民医院肾脏科的急性PQ中毒患者16例,分成HP+HDF组(7例)和HP+CVVH组(9例),观察两种透析模式对中毒患者血、尿PQ浓度的影响及其与临床生化指标的关系。结果 (1)两种模式的透析器均可显著降低PQ浓度(P<0.01);(2)HP+HDF组透析器对中毒患者血液PQ的摄取率、清除率均显著高于HP+CVVH组(P<0.05);(3)HP+HDF组患者血液PQ浓度在透析开始2 h内逐渐降低,但2 h后3例患者PQ浓度再次升高,而HP+CVVH组患者在透析12 h内显著下降,之后维持在较低水平;(4)透析后HP+CVVH组血中PQ浓度较透析前显著降低(P<0.01),HP+HDF组则降低不明显(P>0.05);两组透析后尿中PQ浓度均较透析前显著降低(P<0.01);透析前后血液及尿液中PQ浓度下降百分率HP+CVVH模式均显著高于HP+HDF(P<0.01);(5)HP+CVVH组患者第7天的丙氨酸氨基转移酶、天冬氨酸氨基转移酶、血肌酐、尿素氮与第3天相比显著降低(P<0.05),HP+HDF组则无明显变化(P>0.05)。结论两种透析模式均能有效清除中毒患者血、尿中的PQ,但HP+CVVH透析模式更加高效平稳,避免了透析中血液PQ浓度的再次增高。研究为HP+CVVH和HP+HDF技术应用于百草枯中毒抢救提供了临床实验依据。
Objective To explore the clearance effect of hemoperfusion combined with hemodiafiltration (HP + HDF) and hemoperfusion combined with continuous venovenous hemofiltration (HP + CVVH) on paraquat poisoning in patients with paraquat poisoning. Methods Sixteen patients with acute PQ intoxication admitted to Department of Nephrology, the Tenth People’s Hospital of Shanghai from August 2013 to December 2015 were divided into HP + HDF group (n = 7) and HP + CVVH group (n = 9) Effect of Dialysis Mode on Concentration of PQ and Blood PQ in Poisoning Patients and Its Relationship with Clinical Biochemical Indexes. Results (1) The dialyzer of both modes could significantly reduce the concentration of PQ (P <0.01). (2) The uptake rate and clearance rate of PQ in HP + HDF group were significantly higher than those in HP + CVVH group (P <0.05). (3) The blood PQ concentration in HP + HDF group decreased gradually within 2 h after dialysis, but in 3 h after 2 h, PQ concentration increased again. In HP + CVVH group, (4) After dialyzing, the blood PQ concentration in HP + CVVH group was significantly lower than that before dialysis (P <0.01), but not in HP + HDF group (P> 0.05) The PQ concentration in urine after dialysis was significantly lower than that before dialysis (P <0.01). The percentage of HP and CVVH in the blood and urine before and after dialysis were significantly higher than that of HP + HDF (P <0.01) In the CVVH group, the levels of alanine aminotransferase, aspartate aminotransferase, serum creatinine and urea nitrogen on the 7th day were significantly lower than those on the 3rd day (P <0.05), but no significant changes were found on the HP + HDF group (P> 0.05). Conclusion Both dialysis modes can effectively remove the PQ in the blood and urine of poisoning patients, but the dialysis mode of HP + CVVH is more efficient and stable, which avoids the resurgence of blood PQ concentration during dialysis. The research provided the clinical experimental basis for the application of HP + CVVH and HP + HDF in paraquat poisoning rescue.