血液灌流并连续性肾脏替代治疗和透析滤过对中毒患者百草枯的清除作用

发布时间：2018-12-19 16:41

【摘要】：目的:探索血液灌流联合血液透析滤过(Hemoperfusion+Hemodafiltration)和血液灌流联合连续性静脉-静脉血液滤过(Hemoperfusion+Continuous veno-venous Hemofiltration)对中毒患者百草枯(Paraquat,PQ)的清除作用特点。方法:选择2013年8月至2015年12月入住我科的急性PQ中毒患者16例,分成HP+HDF组(n=7)和HP+CVVH组(n=9),观察该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血中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2h内逐渐降低,但2h后3位患者PQ浓度再次升高,而HP+CVVH组患者在透析12h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天的谷丙转氨酶(alanine transaminase,ALT)、谷草转氨酶(aspartate aminotransferase,AST)、血肌酐(serum creatinine,SCr)、尿素氮(blood urea nitrogen,BUN)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。本研究为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 effects of hemoperfusion combined with hemodiafiltration (Hemoperfusion Hemodafiltration) and continuous veno-venous hemofiltration (Hemoperfusion Continuous veno-venous Hemofiltration) on the clearance of paraquat (Paraquat,PQ) in poisoning patients. Methods: sixteen patients with acute PQ poisoning admitted to our department from August 2013 to December 2015 were divided into HP HDF group (n = 7) and HP CVVH group (n = 9). The effect of urinary PQ concentration and its relationship with clinical biochemical indexes. Results: (1) both models of dialyzer could significantly reduce the concentration of PQ in blood (P0.01); (2) HP HDF dialyzer's uptake rate and clearance rate of PQ in poisoned patients were significantly higher than that in HP CVVH group (P0.05); (3) the concentration of PQ in) HP HDF group decreased gradually within 2 h after dialysis, but the concentration of PQ in 3 patients increased again 2 hours after dialysis, while that in HP CVVH group decreased significantly within 12 h of dialysis, and then maintained at a lower level. (4) after dialysis, the concentration of PQ in HP CVVH group was significantly lower than that in pre-dialysis group (P0.01), HP HDF group, P0.01), HP HDF group was not significantly decreased (P0.05), the urine PQ concentration in both groups was significantly lower than that in pre-dialysis group (P0.01). The decreased percentage of PQ in blood and urine before and after dialysis was significantly higher in HP CVVH model than that in HP HDF (P0.01). (5) the levels of alanine aminotransferase (alanine transaminase,ALT), alanine aminotransferase (aspartate aminotransferase,AST), serum creatinine (serum creatinine,SCr), urea nitrogen (blood urea nitrogen,BUN) in) HP CVVH group were significantly lower than those on the 3rd day (P0.05). There was no significant change in HP HDF group (P0.05). Conclusion: both hemodialysis models can effectively clear the blood of poisoned patients, but the HP CVVH dialysis mode is more efficient and stable in urine, which avoids the further increase of PQ concentration in the hemodialysis. This study provides a clinical experimental basis for the application of HP CVVH and HP HDF techniques in the rescue of paraquat poisoning.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R595

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