| Objectives: Through the observation of the patients with paraquat poisoning based on comprehensive symptomatic treatment,who used hemoperfusion(HP) and hemodialysis(HD) treatment, with different hemoperfusion running device HA230, HA330, patients of two groups had no difference in survival rate, damages on liver,kidney and lung. We can provide some clinical basis for the treatment methods of blood purification and the choices of perfusion device.Methods: Selected the paraquat poisoning patients as research objects ,who visited the Second Hospital of Hebei Medical University emergency department from July 2007 to December 2008.And used the retrospective study.All the patients were perfused with hemoperfusion(HP) and hemodialysis (HD) with integrated symptomatic treatment measures. Of which, 14 cases with perfusion HA230, 108 cases with perfusion HA330. The criteria of inclusion: physical health in the past, the poisoning came for treatment within 4 hours,oral poisoning, gastric lavage for poisoning treatment within 2 hours, within 6 hours of oral activated carbon adsorption poison, catharsis success within 24 hours, 12 hours for hemodialysis and hemoperfusion, once every twelve hours for three days, were treated six times, to estabilish the bridge between the artery and vein when hemoperfused,the same drug treatment used in the same time, a review of liver and kidney function lung CT every three days. The criteria of extration:combined with chronic disease in the past;combined with other drug poisoning;non-oral poisoning or gastric lavage for poisoning treatment longer than 2 hours, within 6 hours of non-oral activated carbon adsorption poison, catharsis success longer than 24 hours, the time of hemodialysis and hemoperfusion longer than 12 hours or not insist on hemodialysis and hemoperfusion once every twelve hours for three days, were treated six times, to estabilish the bridge between the vein and vein when hemoperfused.Among these patients ten with HA230 were selected,the male and female were both five. Thirty-six were selected with HA330,the male were sixteen,the female were twenty. It had no statistical significance (P> 0.05) in these two groups about gender, measured the blood concentration, poisoning severity index (SIPP=blood concentration * admission time), admission time,multiple organ failure occurred when admission,and clinical performance,it was of comparable. Observed survival rates of these two groups.Impaired liver function by comparing the sign of enzyme alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and total red pigment (TBIL), direct bilirubin (DBIL) impaired liver function abnormalities occur time damage rate of recovery of liver function impairment. According to serum creatinine, blood urea nitrogen to observe the number of damaged renal function and calculate the damage rate. According to the CT performance of patients'lung,it divided into the mild,the moderate and the severe ,according this to judge whether the damaged lung performance of these two groups had difference or not. Mild: mild interstitial change in lungs, a small amount of pleural effusion and a single lobe of seeping. Moderate: seepage and ground glass-like changes in lungs, a moderate amount of pleural effusion. Severe: seepage and a large number of ground glass changes in lungs, large pleural effusion, pericardial effusion and lung consolidation. To compare the damaged conditions of these two groups.Statistical analysis used SASv8.0 package for processing. All data were normal after testing the normal distribution of measurement data with a mean±standard deviation ( x±S). Enumeration data with the correction of chi-square test; ranked data used Rank test.It was considered statistically difference when P<0.05.Results: 1 Perfusion with hemoperfusion HA230 of ten people, four were survived, six were died.Among thirty-six people with hemoperfusion HA330,twenty-four were survived, twelve were died. The patients'survival rate with group HA230 was 40%, the rate was 66.7% with group HA330.Through Compared between the two groups,χ2 = 1.3510, P = 0.2415> 0.05 ,it had no statistical difference that the survival rate was no difference between these two groups.2 The comparison of liver function damage in patients of these two groups: there were eight patients of group HA230 who had suffered from liver function damage, the other two patients, one case without liver function damage was alive, the other was dead in respiratory failure who had no liver function damage. Five people were dead among the eight impaired people , one case of the three survived patients whose liver function returned to normal, two cases of liver function had not yet returned to normal after discharge; twenty-three patients in group HA330 were suffered from liver function damage, thirteen patients had not appeared liver function damage , among the thirteen patients ,five patients who did not show any liver damage had been dead in respiratory failure, eight patients survived who had never been damaged liver function. Among the twenty-three patients who was suffered from liver damage, seven patients were dead and sixteen patients survived. Among the sixteen patients,seven patients'liver function returned to normal, nine patients had not returned to normal after discharge. The damaged rate was 80% in patients of group HA230, the rate was 63.9% in patients of group HA330, comparison between the two groupsχ2 = 0.3366, P = 0.5618> 0.05,it had no statistical difference. The average time was 4.4±4.7 days when appeared liver function damage in patients of group HA230; The average time was 6.1±3.8 days when appeared liver function damage in patients of group HA330. Compared the time when two groups appeared liver function damaged by t test,t =- 1.04, P = 0.3066> 0.05, it had no statistical difference that the comparison of the days when the patients of two groups appeared liver function damaged had no difference. The recovery rate was 12.5% in patients of group HA230, the rate was 30.4% in group HA330. Comparison between the two groupsχ~2 = 0.2804, P = 0.5964> 0.05,it had no stastical difference that there was no difference in recovery rate in patients'liver function in the two groups. 3 The comparison of renal function damage in patients of these two groups: one occurred renal function damage in patients of group HA230, two occured in group HA330.The damage rate of renal function was 10% in patients in group HA230, the rate was 0.1% in group HA330. Comparison between the two groupsχ~2 = 0.0000, P = 1.00> 0.05 ,it had no statistical difference that there was no difference in the damage rate of renal function damage in the patients of these two groups.4 The comparison of lung lesions on CT in patients of the two groups: CT of lung in four cases were normal in patients of group HA230, one person was of mild performance, one was of moderate expression, four were of severe manifestations. Four patients were died within six days, two patients were died within twelve days. Lung CT in eight cases were normal in patients of group HA330, eighteen person was of mild performance, eight was of moderate expression,two were of severe manifestations. Ten patients were died within six days, two patients died within twelve days.Two groups of lung lesions performance in CT by the Rank test, Z =- 1.6168, P = 0.1059> 0.05,it had no stastical difference that the comparison between the lung CT lesions in patients of two groups has no difference.Conclusion: 1 Combined with hemodialysis HA230 and HA330 to repeat purification of the blood paraquat have effects of clearing, and can improve patients'survival rate, reduce organ damage.2 Although the survival rate of patients in these two groups, was no statistically difference with hepatic and renal dysfunction and pulmonary lesions on CT. But the group HA330 was to improve survival and reduce organ damage better than the trend of HA230. |
PDF Full Text Request