血液灌流血液滤过及其联合使用在治疗百草枯-第三军医大学学报.DOC

PAGE PAGE 1 血液灌流、持续静脉－静脉血液滤过在治疗百草枯中毒中的疗效观察 李晓萍、蒲友敏、邓朝霞、文亮 第三军医大学西南医院急救部 重庆市沙坪坝区高滩岩 400038 【摘要】　目的: 总结血液灌流(HP) 与连续性静脉－静脉血液滤过(CVVH) 对百草枯（PQ）中毒患者的疗效，以便探讨更加有效的治疗模式。方法: 回顾性分析了54 例PQ 中毒患者，分成对照（常规治疗）组（14人）及试验组（40人），两组均给予常规治疗，试验组加予血液灌流（HP）或持续血液滤过(CVVH)或血液灌流＋持续血液滤过(HP+CVVH)，比较生存率、死亡生存天数、MODS发生率、肺纤维化发生率的情况。结果: 试验组较对照组死亡生存天数明显增加，以HP+CVVH组增加最为显著；4h内行HP治疗组的生存率较＞4h组升高，而MODS的发生率降低。结论: CVVH 能明显延长PQ中毒患者的生存时间，有效降低早期死亡率，并有望降低整体死亡率；早期、足够的HP治疗能够改善PQ中毒患者的预后，提高生存率；合理的HP及CVVH联合使用有望提高PQ中毒患者的整体 救治成功率。 【主题词】　百草枯；中毒；血液灌注；血液滤过 Investigation of the effect of Hemoperfusion，continuous venous-venous hemofiltration on treatment of paraquat poisoning LI Xiaoping, PU Youmin,DENG Zhaoxia,WEN Liang Southwest hospital Third military university Chongqing 400038 【Abstract】AIM : To investigate the effect of HP and CVVH on treatment of paraquat poisoning,hope to find a more effective way of treatment. METHODS: Retrospective analysis of 54 patients admitted with a diagnosis of paraquat poisoning. All patients were given conventional therapy, The control group ( n = 14) received conventional therapy, The experimental group ( n = 40) add HP or CVVH or HP+CVVH therapy. Survival rate, living days ,MODS rate and pulmonary fibrosis rate between groups were analyzed. RESULTS: The living days of the experimental group was more than that of the control group, especially the subset with HP+CVVH had most significant difference. Survival rate was higher in the subset with HP that been given in 4 hours than in the subset (HP ＞4h), MODS rate was lower in the former 。CONCLUSION: CVVH can prolong the live time and reduce the mortality rate of earlier period,it would be a hope of reducing total mortality rate.early and adequate give of HP is able to improve the prognosis and survival rate. Reasonable use of HP and CVVH would a way to promote the entire remedy success. 【Keywords】paraquat; poisoning; hemoperfusion; hemofiltration 百草枯( Paraquat, PQ,又名克无踪、对草快) ,其中毒患者死亡率极高 ,国外报道病死率40% ～50%[1]而国内个别报道高达80%以上,至今尚缺少特异