血液灌流并连续性肾脏替代治疗和透析滤过治疗百草枯中毒疗效研究

发布时间：2018-02-16 13:24

本文关键词： 百草枯中毒血液灌流血液透析滤过连续性静脉-静脉血液滤过　出处：《中国实用内科杂志》2017年07期 　论文类型：期刊论文

【摘要】：目的探索血液灌流联合血液透析滤过(HP+HDF)和血液灌流联合连续性静脉-静脉血液滤过(HP+CVVH)对百草枯中毒患者百草枯(PQ)的清除作用。方法选择2013年8月至2015年12月入住上海市第十人民医院肾脏科的急性PQ中毒患者16例,分成HP+HDF组(7例)和HP+CVVH组(9例),观察两种透析模式对中毒患者血、尿PQ浓度的影响及其与临床生化指标的关系。结果 (1)两种模式的透析器均可显著降低PQ浓度(P0.01);(2)HP+HDF组透析器对中毒患者血液PQ的摄取率、清除率均显著高于HP+CVVH组(P0.05);(3)HP+HDF组患者血液PQ浓度在透析开始2 h内逐渐降低,但2 h后3例患者PQ浓度再次升高,而HP+CVVH组患者在透析12 h内显著下降,之后维持在较低水平;(4)透析后HP+CVVH组血中PQ浓度较透析前显著降低(P0.01),HP+HDF组则降低不明显(P0.05);两组透析后尿中PQ浓度均较透析前显著降低(P0.01);透析前后血液及尿液中PQ浓度下降百分率HP+CVVH模式均显著高于HP+HDF(P0.01);(5)HP+CVVH组患者第7天的丙氨酸氨基转移酶、天冬氨酸氨基转移酶、血肌酐、尿素氮与第3天相比显著降低(P0.05),HP+HDF组则无明显变化(P0.05)。结论两种透析模式均能有效清除中毒患者血、尿中的PQ,但HP+CVVH透析模式更加高效平稳,避免了透析中血液PQ浓度的再次增高。研究为HP+CVVH和HP+HDF技术应用于百草枯中毒抢救提供了临床实验依据。
[Abstract]:Objective to investigate the effect of hemoperfusion combined with hemodiafiltration (HP HDF) and hemoperfusion combined with continuous veno-venous hemofiltration (CVVH) on the clearance of paraquat poisoning patients with paraquat poisoning from August 2013 to December 2015. Sixteen patients with acute PQ poisoning were admitted to the Renal Department of Shanghai 10th people's Hospital. The patients were divided into HP HDF group (n = 7) and HP CVVH group (n = 9). The effect of urine PQ concentration and its relationship with clinical biochemical indexes. Results: both models of dialyzer could significantly reduce the uptake rate of PQ by dialyzer in the group of P0.01HP-2HP HDF. The clearance rates were significantly higher in HP CVVH group than in HP CVVH group (P 0.05). PQ level in HP HDF group gradually decreased within 2 h after hemodialysis, but it increased again in 3 cases 2 h later, while that in HP CVVH group decreased significantly within 12 h after dialysis. After hemodialysis, the blood PQ level of HP CVVH group was significantly lower than that of pre-dialysis group, the P0.01 and HP HDF group was not significantly decreased, the urine PQ level of both groups was significantly lower than that of pre-dialysis group, and the blood and urine PQ levels before and after hemodialysis were significantly lower than those before and after dialysis. The percentage of concentration decrease in HP CVVH pattern was significantly higher than that in HP HDFV P0.01P0. 01 HP CVVH group on the 7th day, and the level of alanine aminotransferase in HP CVVH group was significantly higher than that in HP CVVH group. The levels of aspartate aminotransferase, serum creatinine and urea nitrogen were significantly lower in HDF group than on the 3rd day. Conclusion both hemodialysis models can effectively remove PQs from blood and urine of poisoned patients, but HP CVVH dialysis model is more efficient and stable. The study provided a clinical experimental basis for the application of HP CVVH and HP HDF techniques to the rescue of paraquat poisoning.
【作者单位】：安徽医科大学上海十院临床学院;同济大学附属上海市第十人民医院肾脏风湿科;
【基金】：国家自然科学基金(81671897,81270136)
【分类号】：R595.4

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