双重血浆分子吸附系统治疗百草枯所致肝脏损害的效果观察与护理

目的　探讨双重血浆分子吸附系统（double plasma molecular absorb system，DPMAS）应用在治疗百草枯中毒所致肝脏损害中的效果与护理技术。方法　选取2018年1月至2020年1月间由广州市第十二人民医院急诊科收治的百草枯中毒患者68例，以随机数字表法分为对照组和观察组，各34例。对照组男12例，女22例，年龄（44.26±8.48）岁；观察组男13例，女21例，年龄（45.33±8.26）岁。两组均采取DPMAS治疗，分别采取常规护理及针对性护理，比较护理后两组患者检验指标、治疗效果及并发症发生率。符合正态分布的计量资料以（x±s）表示，组间比较采用独立样本t检验，计数资料以例（%）表示，组间比较采用卡方校验。结果　护理后，两组患者血液中百草枯浓度、总胆红素（TBIL）、总胆汁酸（TBA）、谷丙转氨酶（ALT）、谷草转氨酶（AST）、血氨（NH₃）、白蛋白（Alb）、白细胞介素6（IL-6）均明显小于护理前（均P<0.05），两组患者各项指标对比，差异均无统计学意义（均P>0.05）。观察组有效率88.2%（30/34），高于对照组的76.5%（26/34），但差异无统计学意义（P>0.05）；观察组置管处血肿或出血、肺部感染、低血压、寒战、凝血的总发生率均明显低于对照组（P<0.05）。结论　DPMAS作为人工肝支持系统的一种，应用在百草枯中毒所引起的肝脏损害治疗中，能够有效清除血液中的百草枯及其他毒性物质，改善肝脏功能，在治疗时配合以针对性的护理，能降低并发症的发生，提高治疗的安全性。

Observation and nursing care of patients with paraquat-induced liver damage treated by dual plasma molecular adsorption system

Objective　To explore the nursing technology of dual plasma molecular adsorption system (DPMAS) in the treatment of liver damage caused by paraquat poisoning. Methods　Sixty-eight patients with paraquat poisoning admitted to Emergency Department, Guangzhou 12th People's Hospital from January 2018 to January 2020 were selected and divided into a control group and an observation group by the random number table method, with 34 cases in each group. The control group had 12 males and 22 females, and were (44.26±8.48) years old. The observation group had 13 males and 21 females, and were (45.33±8.26) years old. All the patients were treated by DPMAS. The control group took routine nursing, and the observation group took targeted nursing. The test indicators, treatment effects, and incidences of complications of the two groups were compared after the nursing. The measurement data of normal distribution were expressed as (x±s) and compared between the two groups by independent-sample t test. The enumeration data were expressed as cases (%) and were compared between the two groups by chi-square test. Results　There were statistical differences in paraquat concentration, total bilirubin (TBIL), total bile acid (TBA), glutamic-pyruvic transaminase (ALT), aspartate aminotransferase (AST), blood NH₃, albumin (Alb), and interleukin-6 (IL-6) between before and after the nursing in both groups (all P<0.05), but no between the two groups (all P>0.05). The effective rate was 88.2% (30/34) in the observation group, and was 76.5% (26/34) in the control group, with no statistical difference (P>0.05). The incidence of hematoma or hemorrhage, pulmonary infection, hypotension, shivering, and coagulation in the observation group was significantly lower than that in the control group (P<0.05). Conclusion　DPMAS as a kind of artificial liver support system applied in the treatment of liver damage caused by paraquat poisoning can effectively remove paraquat and other toxic substances in blood, improve their liver function and treatment safety, cooperate with targeted nursing in treatment, and reduce the incidence of complications.