Early Hemoperfusion May Improve Survival of Severely Paraquat-Poisoned Patients 英文参考文献.docVIP

EarlyHemoperfusionMayImproveSurvivalofSeverely Paraquat-PoisonedPatients Ching-WeiHsu1,2,Ja-LiangLin1,2*,Dan-TzuLin-Tan1,2,Kuan-HsingChen1,2,Tzung-HaiYen1,2 ,Mai- SzuWu2,3,Shih-ChiehLin1,2 1DivisionofClinicalToxicology,DepartmentofNephrology,ChangGungMemorialHospital,Lin-KouMedicalCenter,Taoyuan,Taiwan,RepublicofChina,2ChangGung UniversityandSchoolofMedicine,Taoyuan,Taiwan,RepublicofChina,3DepartmentofNephrology,KeelungChangGungMemorialHospital,Keelung,Taiwan,Republic ofChina Abstract Background:Thousandsofparaquat(PQ)-poisonedpatientscontinuetodie,particularlyindevelopingcountries.Although animalstudiesindicatethathemoperfusion(HP)within224hafterintoxicationeffectivelyreducesmortality,theeffectof earlyHPinhumansremainsunknown. Methods:WeanalyzedtherecordsofallPQ-poisonedpatientsadmittedto2hospitalsbetween2000and2009.Patients weregroupedaccordingtoearlyorlateHPandhigh-dose(oralcyclophosphamide[CP]andintravenousdexamethasone [DX]) or repeated pulse (intravenous methylprednisolone [MP] and CP, followed by DX and repeated MP and/or CP) PQ therapy. Early HP was defined as HP ,4h, and late HP, as HP $4h after PQ ingestion. We evaluated the associations between HP ,4h, ,5h, ,6h, and ,7h after PQ ingestion and the outcomes. Demographic, clinical, laboratory, and mortalitydatawereanalyzed. Results: The study included 207 severely PQ-poisoned patients. Forward stepwise multivariate Cox hazard regression analysisshowedthatearlyHP,4h(hazardratio[HR]=0.38,95%confidenceinterval(CI)0.16–0.86;P=0.020)orHP, 5h (HR=0.60, 95% CI: 0.39–0.92; P=0.019) significantly decreased the mortality risk. Further analysis showed that early HP reducedthemortalityriskonlyinpatientstreatedwithrepeatedpulsetherapy(n=136),butnothigh-dosetherapy(n=71). Forward stepwise multivariate Cox hazard regression analysis showed that HP ,4.0h (HR=0.19, 95% CI: 0.05–0.79; P=0.022)or,5.0h(HR=0.49,95%CI:0.24–0.98;P=0.043)afterPQingestionsignificantlydecreasedthemortalityriskin repeatedpulsetherapypatients,afterad