| BackgroundHemoperfusion is one of the most important methods for the clinical treatment of acute paraquat poisoning,and plays an important role in the removal of toxins in patients[1].Thrombelastography(TEG)is a viscoelastic test for thromboembolism,which requires close monitoring of clotting function to avoid coagulation dysfunction.ObjectiveThe evaluation effect of TEG/CCT and arteriovenous ultrasound on thrombosis and bleeding risk in patients with paraquat poisoning treated by hemoperfusion is utilized to provide the basis for individualized blood purification guided by TEG and prognosis judgment in the future.MethodsScreening since October 30,2019 to December 31,2020,shandong university qilu hospital emergency department were 2/1/1 scheme(namely admitted to hospital 24 hours adept two blood perfusion,and then once every 24 hours,a total of 3 days 4)blood perfusion of 76 cases of patients with paraquat poisoning,were retrospectively study,inclusion criteria:1)there is a clear history of oral paraquat poisoning;2)Completed 2/1/1 perfusion therapy regimen;3)Have detailed medical records(including general information,history,physical examination,treatment plan,etc.).Exclusion criteria:1)was not admitted with oral paraquat poisoning;2)Oral paraquat poisoning is unstable;3)there is coagulation related disease before taking pesticide;4)Incomplete records of case data;5)Two or more times of hemoperfusion in other hospitals.Excel statistical software was used to input and establish a database.All clinical data of eligible patients were collected,and SPSS 25.0 was used for statistical analysis.Results1.The semi-quantification of urine within 12 hours in non-thrombosis group was 40.69+20.10μg/ml less than that in thrombosis group 54.58±26.86μg/ml,and the difference was statistically significant.Before perfusion,there were no significant differences inCI,MA,R between the two suites.After perfusion,the R value of the non-thrombosis group was 9.44±3.14 min dramatically higher than that of the thrombosis group 7.44±1.67min,and the platelet count of the thrombosis suites was 266.13±113.16 min higher than that of the non-thrombosis group 211.29±93.90 min.There was no correlation between EPL and LY30 test results and the length of time(days)of thrombus disappearance after Qilu regimen.2.A total of 76 patients were included in the non-bleeding group,the mild bleeding group and the severe bleeding group.There were 52 patients in the non-bleeding group,including 35 males and 17 females.In the bleeding group,there were 24 cases,including 12 males and 12 females.In the mild bleeding group,there were 19 cases,including 10 males and 9 females.There were 5 cases in severe bleeding group,including 2 males and 3 females.The age of non-bleeding group was 40.29±16.74 years old,the age of bleeding group was 41.75±14.80 years old,the age of mild bleeding group was 40.84±15.58 years old,and the age of severe bleeding group was 45.2±2.19 years old.Semi-quantitation of urine was 47.5±24.48μg/ml in the non-bleeding group,44.58±24.13μg/ml in the bleeding group,44.74±21.95μg/ml in the mild bleeding group,and 44±34.35μg/ml in the severe bleeding group.There were no statistically significant differences in age,sex and semi-quantitative urine determination of paraquat.3.The CI value of the non-bleeding group(-2.02±5.38)was higher than that of the bleeding group(-5.61±5.20),while APTT and PT were significantly lower than that of the bleeding group,with statistical difference.The time of PT in mild bleeding group was shorter than that in severe bleeding group,but the number of PLT was more than that in mild bleeding group.Receiver-operating characteristic curve was drawn to analyze the prognostic value of CI/APTT/PT in predicting bleeding,and the difference was not statistically significant.4.34 patients in paraquat mild and moderate poisoning group,including 26 males and 8 females;There were 42 patients in severe paraquat poisoning group,including 21 males and 21 females.There was a difference in the sex ratio between the two groups of patients.The age of paraquat mild and moderate poisoning group was 40.41±14.24 years old;The severe paraquat poisoning group was 41.02 ± 17.57 years old,and there was no significant difference in age between the two groups.5.There were 9 patients with unmeasured lower extremity venous ultrasound,34 patients with mild or moderate paraquat poisoning,and 33 patients with severe paraquat poisoning.The thrombosis rate was significantly different between the two groups.The thrombosis rate increased significantly with the aggravation of poisoning severity.The bleeding rate was also significantly different between the two groups,and the bleeding increased significantly with the aggravation of poisoning severity.6.A total of 65 patients were excluded from the 11 patients who received one perfusion treatment in another hospital at the time of admission,including 26 patients with mild or moderate paraquat poisoning and 39 patients with severe paraquat poisoning.There were no significant differences in R,K,MA and CI between the two groups before perfusion.After perfusion treatment,MA value and PLT number were significantly different,with statistical significance,while the other indicators were not statistically significant.Conclusions1.Age and gender have no effect on the formation of thrombus and bleeding,while the semi-quantitative urine within 12 hours has an effect on the formation of thrombus.The higher the concentration is,the greater the dose is,and the greater the possibility of thrombosis is,but it has no effect on the formation of bleeding.2.The R value and PLT of patients after perfusion therapy were correlated with thrombosis,which could predict the formation of thrombosis,while EPL and LY30 were not correlated with the treatment duration of thrombosis,suggesting that this kind of thrombosis was "white thrombosis",which was mainly platelet.CI values APTT and PT were closely related to whether there was bleeding or not,and there was no significant difference in the prognostic value of the three values,while PT and PLT were closely related to the severity of bleeding.3.The difference in gender composition of paraquat mild to moderate poisoning group and severe poisoning group may be due to the deviation caused by fewer patients with mild to moderate poisoning than those with severe poisoning in our hospital,while there was no significant difference in age.With the aggravation of poisoning severity,thrombosis rate and bleeding degree increased significantly.After perfusion therapy,MA value and PLT number changed significantly with the aggravation of poisoning severity. |
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