【摘要】：目的:探索血液灌流聯(lián)合血液透析濾過(Hemoperfusion+Hemodafiltration)和血液灌流聯(lián)合連續(xù)性靜脈-靜脈血液濾過(Hemoperfusion+Continuous veno-venous Hemofiltration)對中毒患者百草枯(Paraquat,PQ)的清除作用特點。方法:選擇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組(n=7)和HP+CVVH組(n=9),觀察該兩種透析模式對中毒患者血、尿PQ濃度的影響及其與臨床生化指標(biāo)的關(guān)系。結(jié)果:(1)兩種模式的透析器均可顯著降低血中PQ濃度(P0.01);(2)HP+HDF組透析器對中毒患者血液PQ的攝取率、清除率,均顯著高于HP+CVVH組(P0.05);(3)HP+HDF組患者血液PQ濃度在透析開始2h內(nèi)逐漸降低,但2h后3位患者PQ濃度再次升高,而HP+CVVH組患者在透析12h內(nèi)顯著下降,之后維持在較低水平;(4)透析后HP+CVVH組血中PQ濃度較透前顯著降低(P0.01),HP+HDF組則降低不明顯(P0.05);兩組透析后尿中PQ濃度均較透前顯著降低(P0.01);透析前后血液及尿液中PQ濃度下降百分率HP+CVVH模式均顯著高于HP+HDF(P0.01);(5)HP+CVVH組患者第7天的谷丙轉(zhuǎn)氨酶(alanine transaminase,ALT)、谷草轉(zhuǎn)氨酶(aspartate aminotransferase,AST)、血肌酐(serum creatinine,SCr)、尿素氮(blood urea nitrogen,BUN)與第3天相比顯著降低(P0.05),HP+HDF組則無明顯變化(P0.05)。結(jié)論:兩種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穩(wěn),避免了透析中血液PQ濃度的再次增高。本研究為HP+CVVH和HP+HDF技術(shù)應(yīng)用于百草枯中毒搶救提供了臨床實驗依據(jù)。
[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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R595

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