血液灌流改善百草枯中毒患者肺组织损伤的临床研究

目的通过对百草枯（paraquat,PQ）中毒后血液灌流（haemoperfusion,HP）治疗前后的临床观察和实验检查分析,评价其在改善PQ中毒后肺损伤的临床应用价值.方法回顾性分析了山东省惠民县人民医院肾内科49例PQ中毒患者,其中27例实施HP（治疗组）,22例未实施HP（对照组）,通过检测患者的动脉氧分压（PaO2）血氧饱和度（SaO2）,二氧化碳分压（PaCO2）,肺流量（VC）,用力肺活量（FVC）,1秒量（FEV1）及肺部影像学改变,比较两组ARDS及MODS发生率综合估价肺损伤的情况.结果在HP组,低氧血症、Ⅰ型呼吸衰竭发生率明显低于对照组（分别为P＜0.05和P＜0.01）;影像学表现明显减轻;限制性通气障碍发生率明显降低.入院时即出现MODS伴（或不伴）ARDS者病情进展迅速,预后不良.结论尽早实施血液灌流不仅能减轻对肺组织的损伤,还能够促进肺泡或肺间质渗出液的吸收,减少肺纤维化的形成.

Clinical research of haemoperfusion to ameliorate pulmonary injury after Paraquat poisoning

Objective To evaluate the therapeutic effect of haemoperfusion (HP) in treating patients with pulmonary injury after Paraquat(PQ) poisoning. Methods Fourty-nine patients were studied retrospectively. Of them, 27 patients received HP therapy(HP group), and the other 22 patients did not (control group). Pulmonary function were evaluated by detecting PaO2, SaO2, PacO2,VC, FVC, FEV1, X-ray changes in chest before and after HP therapy, the incidence of ARDS and MODS were compared. Results In HP group, the incidence of hypoxemia and type I respiratory failure was lower than that in control group (P<0.05 and P<0.01 respectively), the incidence of restrictive hypoventilation and diffuse dysfunction dereased, and manifestions in chest X-ray were lightened after treatment. Patients with MODS with without ARDS when permitted aggravated rapidly and had a poor prognosis. Conclusion Performing HP as soon as possible can not only ameliorate the pulmonary injury but also promote the absorption of vesicle and interstitial exudates, decelerate the formation of pulmonary fibrosis.