环孢素A和连续性静脉-静脉血液滤过对急性口服中重度百草枯中毒的疗效评价

徐娟娟; 曹莹; 黄昌保; 江云; 张锡刚

doi:10.13201/j.issn.1009-5918.2017.12.002

环孢素A和连续性静脉-静脉血液滤过对急性口服中重度百草枯中毒的疗效评价

- 1. 军事科学院军事医学研究院门诊部(北京, 100850);
- 2. 解放军第532医院重症医学科;
- 3. 解放军307医院急诊科
基金项目:
首都医学发展科研基金 (No:2007-3041)

协和-睿E基金 (No:R2014004)

江苏省博士后基金 (No:1402145C)

详细信息

通讯作者: 张锡刚,E-mail:zhangxg101@sina.com

中图分类号: R595.4

收稿日期: 2017-12-11

The effectiveness of continuous veno-venous hemofiltration therapy in patients with moderate to severe paraquat poisoning

- 1. Department of Outpatient, Academy of Military Medical Sciences, Beijing, 100850, China;
- 2. Department of Intensive Care Unit, the 532th Hospital of PLA;
- 3. Department of Emergency Medicine, 307 Hospital of PLA

More Information

Corresponding author: ZHANG Xigang, E-mail: zhangxg101@sina.com

Received Date: 11 December 2017

摘要

摘要: 目的:评价环孢素A和连续性静脉-静脉血液净化(CVVH)对急性口服中重度百草枯(PQ)中毒患者的疗效。方法:采用单中心前瞻性随机对照研究,对85例急性口服中重度PQ中毒患者依据随机数字法随机分成对照组(甲强龙治疗组,26例)、试验组一(甲强龙加环孢素治疗组,31例)和试验组二(甲强龙加环孢素加CVVH治疗组,28例),分析3组患者的病死率、死亡患者的存活时间、30d生存曲线、脏器损伤情况情况。结果:3组患者在性别、服毒量、就诊时间、血PQ浓度、入院时肝肾功能和动脉血氧分压差异均无统计学意义。3组患者肾损伤发生率、肾损伤发生时间、肝损伤发生时间、低氧血症发生时间及死亡患者存活天数差异均具有统计学意义(均P<0.01);3组患者病死率差异无统计学意义(P>0.05),但病死率呈逐渐下降趋势,其中试验组二死亡率分别低于对照组、试验组一分别达26.3%、16.2%;3组患者30d生存曲线分析差异有统计学意义(P<0.05)。结论:CVVH可降低急性中重度PQ中毒患者病死率,延长死亡患者的生存时间,并延长发生肝、肾损伤及低氧血症发生时间,因此CVVH对中重度PQ中毒治疗有效。
- 连续性静脉-静脉血液滤过 /
- 百草枯 /
- 中重度中毒 /
- 疗效
Abstract: Objective:To evaluate the effectiveness of cyclosporin A combined with continuous veno-venous hemofiltration therapy in patients with moderate to severe paraquat poisoning.Method:A single-center, prospective, randomized and controlled trial was carried out, a total of 85 patients with acute moderate to severe PQ poisoning was randomly grouped into control group (methylprednisolone only group, n=26) and trial group one (methylprednisolone+cyclosporine Treatment group, n=31) and trial group two (methylprednisolone + cyclosporin +CVVH treatment group, n=28) according to random number table method.The mortality, survival time, 30 days survival curve, and viscera damage occurrence rate were analyzed.Result:There were no significant difference among the three groups in gender, ingested amount, time of arrived ED, blood PQ concentration, liver and kidney function and arterial oxygen pressure at admission.The incidence of renal injury, the time of renal injury, the time of liver injury, the time of hypoxemia and the number of surviving days of death in the three groups were all statistically different (P<0.01, respectively), while there was no significant difference in the mortality among the three groups (P>0.05), however, there had a gradual downward trend with mortality among those groups, the trial group two had more lower mortality than the other two groups (26.3% lower than control group, 16.2% lower than trial group, respectively), evenmore, there were significant difference among the three groups in 30-day survival curve (Log-rank P<0.05).Conclusion:CVVH can reduce the mortality of patients with acute moderate to severe PQ poisoning, prolong the survival time of died patient, and extend the time of the liver and kidney injuried and hypoxemia.Therefore, CVVH on the treatment of moderate to severe PQ poisoning was effective.
- continuous veno-venous hemofiltration /
- paraquat /
- moderate to severe poisoning /
- effectiveness

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参考文献(30)

[1]	Afzali S, Gholyaf M.The effectiveness of combined treatment with methylprednisolone and cyclophosphamide in oral paraquat poisoning[J].Arch Iran Med, 2008, 11:387-391.
[2]	Senarathna L, Eddleston M, Wilks M F, et al.Prediction of outcome after paraquat poisoning by measurement of the plasma paraquat concentration[J].QJM, 2009, 102:251-259.
[3]	Dinis-Oliveira R J, Duarte J A, Sanchez-Navarro A, et al.Paraquat poisonings:mechanisms of lung toxicity, clinical features, and treatment[J].Crit Rev Toxicol, 2008, 38:13-71.
[4]	Dinis-Oliveira R J, de Pinho P G, Santos L, et al.Postmortem analyses unveil the poor efficacy of decontamination, anti-inflammatory and immunosuppressive therapies in paraquat human intoxications[J].PLoS One, 2009, 4:e7149-e7149.
[5]	Lee E Y, Hwang K Y, Yang J O, et al.Predictors of survival after acute paraquat poisoning[J].Toxicol Ind Health, 2002, 18:201-206.
[6]	Lin J L, Wei M C, Liu Y C.Pulse therapy with cyclophosphamide and methylprednisolone in patients with moderate to severe paraquat poisoning:apreliminary report[J].Thorax, 1996, 51:661-663.
[7]	Perriens J H, Benimadho S, Kiauw I L, et al.Highdose cyclophosphamide and dexamethasone in paraquat poisoning:aprospective study[J].Hum Exp Toxicol, 1992, 11:129-134.
[8]	雒番阳, 刘卓, 黄杨, 等.环磷酰胺与血液净化救治急性百草枯中毒的疗效分析[J].中国急救医学, 2016, 36 (7):643-646.
[9]	王煜, 孔冰冰, 杨文萍.急性百草枯中毒患者血清细胞因子的变化与预后的相关性研究[J].中国急救医学, 2016, 36 (10):897-900.
[10]	Addo E, Poon-King T.Leucocyte suppression in treatment of 72patients with paraquat poisoning[J].Lancet, 1986, 1:1117-1120.
[11]	Lin J L, Lin-Tan D T, Chen K H, et al.Improved survival in severe paraquat poisoning with repeated pulse therapy of cyclophosphamide and steroids[J].Intensive Care Med, 2011, 37:1006-1013.
[12]	Gawarammana I B, Buckley N A.Medical management of paraquat ingestion[J].Br J Clin Pharmacol, 2011, 72:745-757.
[13]	Proudfoot A T, Stewart M S, Levitt T, et al.Paraquat poisoning:significance of plasma-paraquat concentrations[J].Lancet, 1979, 2:330-332.
[14]	Hampson E C, Pond S M.Failure of haemoperfusion and haemodialysis to prevent death in paraquat poisoning.A retrospective review of 42 patients[J].Med Toxicol Adverse Drug Exp, 1988, 3:64-71.
[15]	黄昌保, 张锡刚, 江云, 等.成功救治重度百草枯中毒并发纵隔气肿一例[J].中华临床医师杂志 (电子版), 2011, 5 (7):2164-2166.
[16]	李增攀, 方建江, 夏菁, 等.CTGF与百草枯中毒大鼠肺纤维化相关性的实验研究[J].中国急救医学, 2016, 36 (6):565-568.
[17]	Koo J R, Kim J C, Yoon J W, et al.Failure of continuous venovenous hemofiltration to prevent death in paraquat poisoning[J].Am J Kidney Dis, 2002, 39:55-59.
[18]	张雷, 李桃红.血必净联合血液灌流和连续性静-静脉血液滤过治疗百草枯中毒33例分析[J].中国冶金工业医学杂志, 2011, 28 (3):295-295.
[19]	程丽, 叶钢, 王敏娜, 等.血液灌流串连不同模式连续性血液净化治疗急性百草枯中毒的疗效观察[J].临床急诊杂志, 2016, 17 (10):746-751.
[20]	De Vriese A S, Colardyn F A, Philippe J J, et al.Cytokine removal during continuous hemofiltration in septic patients[J].J Am Soc Nephrol, 1999, 10:846-853.
[21]	Riegel W, Ziegenfuss T, Rose S, et al.Influence of venovenous hemofiltration on posttraumatic inflammation and hemodynamics[J].Contrib Nephrol, 1995, 116:56-61.
[22]	Forni L G, Hilton P J.Continuous hemofiltration in the treatment of acute renal failure[J].N Engl J Med, 1997, 336:1303-1309.
[23]	纪永松, 杜凯阳, 刘洪亮, 等.组合式血液净化救治急性百草枯中毒肺纤维化1例[J].临床急诊杂志, 2016, 17 (07):566-567.
[24]	谢红浪, 季大玺, 龚德华, 等.应用CVVH治疗重症急性胰腺炎[J].肾脏病与透析肾移植杂志, 2000, 9 (6):510-515.
[25]	Lock E A.The effect of paraquat and diquat on renal function in the rat[J].Toxicol Appl Pharmacol, 1979, 48:327-336.
[26]	余海放, 聂虎.百草枯中毒后NF-κB及其下游产物变化的研究[J].四川大学学报 (医学版), 2010, 41 (2):276-279.
[27]	Bismuth C, Scherrmann J M, Garnier R, et al.Elimination of paraquat[J].Hum Toxicol, 1987, 6:63-67.
[28]	Honore P, Hantson P, Fauville J P, et al.Paraquat poisoning."State of the art"[J].Acta Clin Belg, 1994, 49:220-228.
[29]	Lin J L, Leu M L, Liu Y C, et al.A prospective clinical trial of pulse therapy with glucocorticoid and cyclophosphamide in moderate to severe paraquat-poisoned patients[J].Am J Respir Crit Care Med, 1999, 159:357-360.
[30]	Agarwal R, Srinivas R, Aggarwal A N, et al.Immunosuppressive therapy in lung injury due to paraquat poisoning:a meta-analysis[J].Singapore Med J, 2007, 48:1000-1005.