血液灌流联合连续性血液透析滤过治疗急性重度有机磷农药中毒的临床研究

发布时间：2018-08-20 15:18

【摘要】：目的:观察血液灌流(hemoperfusion HP)联合连续性静脉-静脉血液透析滤过(continuous veno-venous hemodiafiltration CVVHDF)技术治疗急性重度有机磷农药中毒的临床疗效。方法:选取2014年01月至2016年10月期间寒亭区人民医院重症医学科收治的63例急性重度有机磷农药中毒(acute severe organophosphorus pesticide poisoning ASOPP)患者,男性29例,女性34例,年龄14-70岁,分为研究组(HP+CVVHDF组,33例)与对照组(HP组,30例)。两组患者在入院后均给予洗胃、导泻、利尿、胆碱酯酶复能药(氯解磷定)、胆碱受体拮抗剂(阿托品、长托宁),同时给予补液、保护多脏器功能等对症支持治疗。对照组入院后尽早行血液灌流治疗,治疗时间2-3小时。研究组在对照组的基础上联合连续性静脉-静脉血液透析滤过治疗,即血液灌流治疗2-3小时后中断治疗,取下灌流器,继续予以连续性静脉-静脉血液透析滤过治疗,治疗时间24-48小时。血液灌流虽可快速清除患者体内的有机磷农药,但是容易造成患者内环境的紊乱,加重脑水肿及其他脏器的损害。而连续性静脉-静脉血液透析滤过技术几乎不改变患者的血浆渗透压,血流动力学稳定,可以调节患者的容量,并且保持机体的酸碱和电解质平衡,既能够持续而有效的清除毒素、避免毒素反跳,又能够清除炎症介质,以避免不可逆的多器官组织损伤,但通常被认为需要高额的治疗费用。本研究中采用血液灌流联合连续性静脉-静脉血液透析滤过的血液净化技术就是利用二者优势互补的特点,观察两组患者的卫生经济学指标:昏迷时间、机械通气时间、血浆炎性因子的水平(肿瘤坏死因子-α、白细胞介素-1β、白细胞介素-6、白细胞介素-8)、平均住ICU天数、平均住ICU费用及临床治愈率。结果:两组患者之间的昏迷时间、机械通气时间、临床治愈率、平均住ICU天数、平均住ICU费用相比较,差异有统计学意义(均p0.05);两组患者血浆炎性因子的水平(肿瘤坏死因子-α、白细胞介素-1β、白细胞介素-6、白细胞介素-8)治疗前后比较,差异有统计学意义(p0.05),研究组治疗后与对照组比较,差异有统计学意义(p0.05)。结论:采用血液灌流(hemoperfusion HP)联合连续性静脉-静脉血液透析滤过(continuous veno-venous hemodiafiltration CVVHDF)技术治疗急性重度有机磷农药中毒患者在清除机体血浆内炎性因子因子方面具有独特的优势,可以显著缩短昏迷时间及机械通气时间,提高临床治愈率,减少在ICU的住院天数和治疗费用,临床疗效显著,是一种安全、经济、有效的杂合血液净化方法。
[Abstract]:Objective: to observe the clinical effect of hemoperfusion (hemoperfusion HP) combined with continuous veno-venous hemodiafiltration (continuous veno-venous hemodiafiltration CVVHDF) in the treatment of acute severe organophosphorus pesticide poisoning. Methods: from January 2014 to October 2016, 63 patients with acute severe organophosphorus pesticide poisoning (acute severe organophosphorus pesticide poisoning ASOPP), male 29, female 34, aged 14-70 years, were selected from Department of intensive Medicine, people's Hospital of Hanting District. They were divided into study group (HP CVVHDF group, n = 33) and control group (HP group, n = 30). Both groups were treated with gastric lavage, catharsis, diuretic, cholinesterase reactivity (chlorophosphamide), choline receptor antagonist (atropine, Changtonin), rehydration, protection of multiple organ function, etc. The control group received hemoperfusion therapy as soon as possible after admission for 2-3 hours. On the basis of the control group, the study group combined with continuous veno-venous hemodiafiltration therapy, that is, after 2-3 hours of hemoperfusion therapy, the treatment was interrupted, the perfusion device was removed, and the continuous veno-venous hemodiafiltration therapy was continued. Treatment time was 24-48 hours. Although hemoperfusion can quickly remove organophosphorus pesticides from patients, it is easy to cause disorder in patients' internal environment and aggravate brain edema and other organ damage. Continuous veno-venous hemodiafiltration has little effect on plasma osmotic pressure, stable hemodynamics, adjusts the volume of the patient, and maintains the balance of acid, base and electrolyte. It can remove toxins continuously and effectively, avoid toxin bouncing, and remove inflammatory mediators to avoid irreversible multiple organ and tissue damage, but it is usually considered to require high cost of treatment. In this study, hemoperfusion combined with continuous veno-venous hemodiafiltration was used to observe the health economic indexes of the two groups: coma time, mechanical ventilation time. The levels of plasma inflammatory factors (tumor necrosis factor- 伪, interleukin-1 尾, interleukin-6, interleukin-8), the average number of days of living in ICU, the average cost of living in ICU and the clinical cure rate. Results: the time of coma, the time of mechanical ventilation, the clinical cure rate, the average days of living in ICU, the average cost of living in ICU were compared between the two groups. The levels of plasma inflammatory factors (tumor necrosis factor- 伪, interleukin-1 尾, interleukin-6, interleukin-8) were compared between the two groups before and after treatment. The difference was statistically significant (p0.05), compared with the control group after treatment (p0.05). Conclusion: hemoperfusion with (hemoperfusion HP) combined with continuous veno-venous hemodiafiltration (continuous veno-venous hemodiafiltration CVVHDF) has a unique advantage in removing plasma inflammatory factors in patients with acute severe organophosphorus pesticide poisoning. It can significantly shorten the time of coma and mechanical ventilation, increase the clinical cure rate, reduce the days of hospitalization and the cost of treatment in ICU. It is a safe, economical and effective method of blood purification for hybrids.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R595.4

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