双重血浆吸附治疗急性百草枯中毒的效果观察

兰薇; 秦曙光; 刘建芳; 郭静仪; 吕敏清

doi:10.16766/j.cnki.issn.1674-4152.002231

双重血浆吸附治疗急性百草枯中毒的效果观察

doi: 10.16766/j.cnki.issn.1674-4152.002231

1.
广州市第十二人民医院肾内科，广东广州 510620
2.
广州市第一人民医院肾内科，广东广州 510180

基金项目:

广东省医学科研基金立项项目 B2021147

详细信息

通讯作者:
秦曙光，E-mail: qin.sg@medmail.com.cn

中图分类号: R595.4 R459.5
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- 文章访问数: 347
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- PDF下载量: 7
- 被引次数: 0
出版历程
- 收稿日期: 2021-03-21
- 网络出版日期: 2022-03-02

Effect of double plasma adsorption of plasma on acute paraquat poisoning

1.
Department of Nephrology, Guangzhou Twelfth People's Hospital, Guangzhou, Guangdong 510620, China

摘要

摘要: 目的探讨双重血浆分子吸附系统(dual plasma molecular adsorption system，DPMAS)对百草枯中毒患者疗效的影响。方法选择2017年3月—2019年8月广州市第十二人民医院收治的急性百草枯中毒患者79例，根据治疗方式差异分为对照组(32例)与观察组(47例)。对照组采取常规治疗，观察组采取常规治疗联合DPMAS技术治疗。比较2组患者的百草枯清除率、存活率与存活时间，以及外周血中百草枯水平、胆红素、丙二醛水平，治疗前后患者的肝肾功能及心肌酶指标水平。结果观察组百草枯清除率为(68.45±2.56)%，高于对照组的(52.60±2.04)%(P < 0.05)；观察组T2[(4.70±1.95)mg/L]、T3[(3.19±1.82)mg/L]、T4[(0.83±0.78)mg/L]血清百草枯水平低于对照组[(6.92±1.37)mg/L、(5.57±0.09)mg/L、(3.52±1.22)mg/L，均P < 0.05]；观察组存活率为78.72%、平均存活时间为(21.69±6.05)d，优于对照组[28.13%、(10.12±3.85)d，均P < 0.05]；治疗后，2组患者外周血中胆红素、丙二醛的浓度均明显降低，组间比较，观察组低于对照组(均P < 0.05)；治疗后，2组患者的谷丙转氨酶、谷草转氨酶、肌酸激酶同工酶、血肌酐等指标均较治疗前降低(均P < 0.05)，观察组减低程度高于对照组(均P < 0.05)。结论 DPMAS技术能快速清除急性百草枯中毒患者血液中百草枯含量，降低胆红素、丙二醛水平，减轻炎症反应及心肌损伤，改善免疫及肝肾功能，延长患者生存时间，提高生存率。
- 百草枯 /
- 中毒 /
- 双重血浆分子吸附系统 /
- 疗效
Abstract: Objective To investigate the effect of dual plasma molecular adsorption system (DPMAS) on patients with paraquat poisoning. Methods A total of 79 patients with acute paraquat poisoning, who were admitted to the Twelfth People's Hospital of Guangzhou from March 2017 to August 2019, were selected and divided into the control group (32 cases) and observation group (47 cases) based on differences in treatment. The control group underwent conventional treatment, and the observation group underwent conventional treatment combined with DPMAS treatment. The clearance rate, survival rate and survival time and the levels of paraquat, bilirubin and malondialdehyde in the peripheral blood were compared between the two groups. In addition, the liver and kidney function and myocardial enzyme index levels of the patients before and after treatment were compared. Results The clearance rate of paraquat in the observation group was (68.45±2.56)%, which was higher than that in the control group [(52.60±2.04)%, P < 0.05], the serum paraquat level in the observation group [T2 (4.70±1.95) mg/L, T3 (3.19±1.82) mg/L and T4 (0.83±0.78) mg/L] were lower than that in the control group [T2 (6.92±1.37) mg/L, T3 (5.57±0.09) mg/L and T4 (3.52±1.22) mg/L], respectively (all P < 0.05). In addition, the survival rate of the observation group was 78.72%, and the survival time was (21.69±6.05) days, which were better than the control group [28.13%, (10.12±3.85) days, all P < 0.05]. After treatment, the concentrations of bilirubin and malondialdehyde in the peripheral blood of the two groups were significantly reduced, of which the observation group was lower than the control group (all P < 0.05). The alanine aminotransferase, aspartate aminotransferase, creatine kinase isoenzymes-MB and serum creatinine levels of the two groups and the other indicators after treatment were lower than those before treatment (all P < 0.05), and the degree of reduction in the observation group was higher than that of the control group (all P < 0.05). Conclusion The DPMAS can rapidly remove the paraquat content in the blood of patients with acute paraquat poisoning, educe the levels of bilirubin and malondialdehyde, reduce inflammation and myocardial damage, improve immunity, liver and kidney function, prolong the survival time of patients and improve survival rate.
- Paraquat /
- Dual plasma molecular adsorption system /
- Efficacy /

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表 1 观察组与对照组患者不同时间血清百草枯水平比较(x±s，mg/L)

组别	例数	T1	T2	T3	T4
观察组	47	14.90±1.71	4.70±1.95^a	3.19±1.82^a	0.83±0.78^a
对照组	32	14.60±1.63	6.92±1.37^a	5.57±0.09^a	3.52±1.22^a
t值		0.780	5.567	7.376	11.962
P值		0.438	< 0.001	< 0.001	< 0.001
注：F_交互=161.709，P_交互 < 0.001；F_时间=51.627，P_时间 < 0.001；F_组间=9.045，P_组间=0.009。与同组T1比较，^aP < 0.05。

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表 2 2组患者外周血中丙二醛、胆红素浓度比较(x±s)

组别	例数	胆红素(μmol/L)		MDA(nmol/mL)
组别	例数	24 h	72 h	24 h	96 h
对照组	32	20.21±1.31	15.21±12.34^a	50.94±9.25	18.66±3.11^a
观察组	47	20.25±1.21	11.33±5.14^a	18.34±2.25	5.12±1.02^a
t值		3.347	26.776	23.237	23.773
P值		0.001	< 0.001	< 0.001	< 0.001
注：与同组24 h比较，^aP < 0.05。

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表 3 2组患者治疗前后肝肾功能与心肌酶谱指标比较(x±s)

组别	例数	ALT(U/L)		AST(U/L)		CK-MB(U/L)		血肌酐(μmol/L)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	32	128.32±16.32	59.32±8.56^a	128.31±15.32	65.63±7.31^a	45.42±6.18	19.34±3.11^a	210.35±18.23	118.34±8.36^a
观察组	47	131.23±17.10	34.62±5.68^a	127.63±16.35	41.62±6.43^a	44.66±6.03	12.64±2.61^a	208.66±17.93	93.32±7.69^a
t值		0.514	7.514	0.699	10.336	0.692	9.338	0.773	12.364
P值		0.669	0.001	0.484	< 0.001	0.48	< 0.001	0.449	< 0.001
注：与同组治疗前比较，^aP < 0.05。

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