序贯性血液净化救治急性百草枯中毒临床研究

目的观察序贯性血液净化救治急性百草枯(paraquat,PQ)中毒的临床疗效。方法选择73例急性PQ中毒患者随机分为对照组和治疗组,对照组给予常规方法治疗,治疗组在对照组基础上给予序贯性血液净化治疗。结果两组治疗7、14 d后除WBC外其他实验室指标比较差异均有统计学意义(均P<0.05),两组治疗后肺部CT表现比较差异均有统计学意义(均P<0.05)。对照组治疗后发生多器官功能衰竭、死亡、存活患者住院时间分别为63.6%、66.7%、(41.5±5.5)d,治疗组分别为27.5%、27.5%、(25.9±4.8)d,两组比较差异均有统计学意义(均P<0.05)。对照组无并发症发生。治疗组在序贯性血液净化过程中出现血压下降4例,经快速补液很快纠正;出现肉眼血尿3例,未行任何特殊处理,序贯性血液净化结束后自然恢复。结论尽早实施序贯性血液净化救治急性PQ中毒能减轻各脏器的损伤,减少肺纤维化的形成,降低死亡率,明显改善患者预后,值得临床推广应用。

Sequential blood purification in the treatment of acute paraquat poisoning

Objective To evaluate the therapeutic effect of sequential blood purification in treating patients with paraquat（PQ） poisoning.Methods Seventy-three patients were randomly divided into two groups：control group and treatment group.The control group was treated with conventional therapy and the treatment group with additional sequential blood purification.Results 7 and 14 days after treatment,significant differences were found between the two groups in all the laboratory data except WBC count（P0.05）.Pulmonary CT findings showed no significant difference in both groups after treatment.In the control group,the incidence rate of multiple organ failure,mortality rate,hospitalization time were 63.6%,66.7%and（41.5±5.5）days respectively.In the treatment group,they were 27.5%,27.5% and（25.9±4.8）days respectively.No complications were found in the control group.Decrease of blood pressure was found in 4 cases in the process of blood purification,which was corrected with rapid fluid replacement.3 cases were found to have gross hematuria and got recovered after blood purification without any special treatment.Conclusion Early application of sequential blood purification in treating paraquat poisoning could reduce the damage of multiple organs,formation of pulmonary fibrosis and mortality rate as well as improve prognosis,which deserves further application in clinical practice.