Effects of hemoperfusion combined with continuous hemodialysis filtration on organ function in patients with acute severe organophosphorus pesticide poisoning
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摘要: 目的 观察对比单纯行血液灌流(hemoperfusion，HP)治疗及HP联合连续性静脉-静脉血液透析滤过(continuous veno-veno hemodiafiltration，CVVHDF)治疗对急性重度有机磷农药中毒患者器官功能影响。方法 收集2016年1月—2022年12月在徐州医科大学附属医院及连云港市第二人民医住院接受HP治疗(HP组，40例)及HP联合CVVHDF治疗(HP+CVVHDF组，38例)的急性重度有机磷农药中毒患者资料。统计学分析采用SPSS 25.0版本处理数据，图形处理采用GraphPad Prism 8.0，组间比较使用独立样本t检验，组内比较使用配对t检验。对非正态分布数据使用Wilcoxon符号秩和检验分析。记录并分析两组一般资料，实验室资料：包括乙酰胆碱酯酶以及肝功能、肾功能、氧合指数、心肌酶、白细胞计数以及炎症因子等指标，并对两组并发症如中间综合征、肺部感染、多器官功能不全综合征(multiple organ dysfunction syndrome，MODS)以及死亡例数进行对比。结果 ① 两组一般资料对比，在意识障碍时间以及住院时间上，HP+CVVHDF组较HP组显著减少，差异有统计学意义(P＜0.05)。②实验室指标：HP+CVVHDF组较HP组胆碱酯酶活性、氧合指数皆显著上升，差异有统计学意义(P＜0.05)；HP+CVVHDF组较HP组血尿素氮、血肌酐、血谷丙转氨酶、血CK-MB、血cTnI、血白细胞、IL-6、TNF-α以及PCT皆显著下降，差异有统计学意义(P＜0.05)。③并发症以及死亡例数：HP+CVVHDF组中间综合征发生1例，HP组3例，HP+CVVHDF组较HP组中间综合征发生率低，但差异无统计学意义(P>0.05)。HP+CVVHDF组较HP组能够显著减少MODS发生率，差异有统计学意义(P＜0.05)。HP+CVVHDF组治疗过程中死亡0例，HP组6例，HP+CVVHDF组较HP组能够显著减少病死率，差异有统计学意义(P＜0.05)。结论 HP+CVVHDF能够快速提升有机磷中毒患者胆碱酯酶活性，并有效改善肝、肾、肺以及心脏等各大器官血清学指标，并显著减低急性重度有机磷农药中毒患者病死率。
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关键词:
- 急性重度有机磷农药中毒 /
- 血液灌流 /
- 连续性静脉-静脉血液透析滤过 /
- 疗效
Abstract: Objective To compare the effects of hemoperfusion(HP) therapy alone and hemoperfusion combined with continuous venous-venous hemodialysis filtration(CVVHDF) on organ function in patients with acute severe organophosphorus pesticide poisoning.Methods The data of patients with acute severe organophosphorus pesticide poisoning who received HP treatment(HP group, 40 cases) and hemoperfusion combined with CVVHDF treatment(HP+CVVHDF group, 38 cases) in Affiliated Hospital of Xuzhou Medical University and Lianyungang Second People's Hospital from January 2016 to December 2022 were collected. SPSS 25.0 was used for statistical analysis, GraphPad Prism 8.0 was used for graphic processing, independent sample T-test was used for comparison between groups, and paired T-test was used for comparison within groups. Wilcoxon signed rank sum test was used to analyze the non-normal distribution data. The general data and laboratory data of the two groups were recorded and analyzed, including cholinesterase, liver function, renal function, oxygenation index, myocardial enzyme, white blood cell count and inflammatory factors, and the complications such as intermediate syndrome, lung infection, multiple organ dysfunction syndrome and death toll were compared between the two groups.Results ① Compared with the general data of the two groups, the time of consciousness disturbance and hospitalization in HP+CVVHDF group was significantly reduced, and the difference was statistically significant(P<0.05). ②Laboratory indexes: compared with HP group, the cholinesterase activity and oxygenation index in HP+CVVHDF group increased significantly, and the difference was statistically significant(P<0.05). The blood urea nitrogen, creatinine, alanine aminotransferase, CK-MB, cTnI, leukocyte, IL-6, TNF-α and PCT in HP+CVVHDF group were significantly lower than those in HP group(P<0.05). ③Complications and deaths: there was 1 case of intermediate syndrome in HP+CVVHDF group and 3 cases in HP group. There was no statistical difference in the incidence of intermediate syndrome between HP+CVVHDF group and HP group(P>0.05). The incidence of MODS in HP+CVVHDF group was significantly lower than that in HP group, and the difference was statistically significant(P<0.05). There was no death in HP+CVVHDF group and there were 6 deaths in HP group. Compared with HP group, HP+CVVHDF group can significantly reduce the mortality, and the difference was statistically significant(P<0.05).Conclusion HP+CVVHDF can rapidly increase cholinesterase activity in patients with organophosphorus pesticide poisoning, effectively improve the serological indexes of liver, kidney, lung and heart, and significantly reduce the mortality of patients with acute severe organophosphorus pesticide poisoning. -
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表 1 两组患者一般资料比较
X±S 组别 HP组(40例) HP+CVVHDF组(38例) χ2/t P 性别/例 0.666 0.187 男 17 18 女 23 20 年龄/岁 40.98±9.59 40.71±8.00 0.895 0.132 中毒剂量/mL 111.65±34.01 109.53±38.26 0.797 0.259 AchE活性/(U/L) 225.30±74.69 213.34±77.98 0.491 0.692 中毒至治疗开始时间/h 5.75±1.52 5.83±1.58 0.828 0.218 
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表 2 两组患者意识障碍时间、住院天数比较
X±S 组别 HP组(40例) HP+CVVHDF组(38例) χ2/t P 意识障碍时间/h 22.15±4.17 12.61±1.67 13.151 ＜0.001 住院时间/d 11.5±2.21 10.18±2.03 2.739 0.008
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表 3 两组患者并发症以及病死率比较
例 项目 HP组(40例) HP+CVVHDF组(38例) χ2 P 中间综合征 3 1 0.212 0.645 肺部感染 9 6 0.565 0.452 MODS 8 1 4.183 0.041 死亡 6 0 4.243 0.039
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