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目的:本研究通过监测急性2,4-二硝基苯酚中毒患者治疗前后血浆毒物浓度的动态变化,从而探讨血液灌流治疗对急性2,4-二硝基苯酚中毒患者的毒物清除疗效及其临床价值。创新点:由于急性2,4-二硝基苯酚中毒患者在临床中较为罕见,其相关毒物代谢动力学资料十分缺乏,且尚未有规范的临床救治方案。本研究创新点主要有:(1)对2,4-二硝基苯酚的毒物代谢动力学进行了必需的探讨和研究;(2)为临床上形成规范的救治方案,提供了科学的实践资料。方法:回顾性分析了16例急性2,4-二硝基苯酚中毒患者的救治经过,其中14例幸存者根据救治中实施树脂-血液灌流治疗的强度和频度差异,分为常规血液灌流组(5例)和强化血液灌流组(9例)。同时,本研究使用超高效液相色谱串联质谱方法对患者救治过程中的血浆毒物浓度进行了动态监测。结论:14例幸存患者的初始血浆2,4-二硝基苯酚浓度为0.25~41.88μg/ml不等,且初始血浆毒物浓度与患者体温高低呈正相关。研究发现,机体对于2,4-二硝基苯酚的清除是缓慢而持久的。根据血浆2,4-二硝基苯酚浓度动态变化计算而得,患者血浆毒物总清除率R3(中毒后第1日至第3日)、R3–7(中毒后第3日至第7日)和R7(中毒后第1日至第7日)分别为(53.03±14.04)%、(55.25±10.50)%和(78.29±10.22)%。其中,强化血液灌流组患者的血浆毒物总清除率R3、R3–7和R7均显著高于常规血液灌流组,差异有统计学意义(P<0.05)。此外,强化血液灌流组患者的2,4-二硝基苯酚清除半衰期(t1/2)明显短于常规血液灌流组,差异有统计学意义(P<0.05)。因而,本研究显示高强度、高频度地实施血液灌流治疗有利于急性2,4-二硝基苯酚中毒患者清除毒物。
Objective: In this study, by monitoring the dynamic changes of plasma concentrations of toxic 2,4-dinitrophenol poisoning patients before and after treatment to explore the effect of hemoperfusion on patients with acute 2,4-dinitrophenol poisoning and its clinical efficacy value. Innovation: Since acute 2,4-dinitrophenol poisoning is rare in clinical practice, the relevant toxicokinetic data are lacking and there is no standardized clinical treatment plan. The main innovations of this study are: (1) The toxicokinetics of 2,4-dinitrophenol has been studied and studied as necessary; (2) scientific and practical information has been provided for the formation of a standardized treatment plan . Methods: A retrospective analysis of 16 patients with acute 2,4 - dinitrophenol poisoning after treatment, of which 14 survivors were treated according to the treatment of resin - hemoperfusion treatment intensity and frequency differences, were divided into conventional hemoperfusion group (5 cases) and intensive hemoperfusion group (9 cases). At the same time, this study used ultra-performance liquid chromatography tandem mass spectrometry to monitor the concentration of plasma toxins during the treatment of patients. CONCLUSIONS: The initial plasma concentrations of 2,4-dinitrophenol in 14 survivors ranged from 0.25 to 41.88 μg / ml, and the initial plasma plasma concentrations were positively correlated with the patient’s body temperature. The study found that the body of 2,4-dinitrophenol removal is slow and lasting. Calculated according to the dynamic changes of plasma 2,4-dinitrophenol concentration, the total plasma toxin clearance rate of patients R3 (1 to 3 days after poisoning), R3-7 (3 to 7 days after poisoning) And R7 (53.03 ± 14.04)%, (55.25 ± 10.50)% and (78.29 ± 10.22)%, respectively, from the 1st day to the 7th day after poisoning. Among them, the total plasma toxin clearance rate R3, R3-7 and R7 in intensive hemoperfusion group were significantly higher than those in conventional hemoperfusion group, the difference was statistically significant (P <0.05). In addition, the half-life of 2,4-dinitrophenol clearance (t1 / 2) was significantly shorter in the intensive hemoperfusion group than in the conventional hemoperfusion group, with a statistically significant difference (P <0.05). Therefore, this study shows that high intensity, high frequency of hemoperfusion therapy is conducive to acute toxic 2,4-dinitrophenol poisoning patients.