| This study includes three parts.The first part aims to review the epidemiological characteristics of 1036 cases of acute severe poisoning in Jilin Province,and to highlight the fact that although the sale of paraquat has been banned for many years,it still exists harmfully and remains the most toxic poisoning type in Jilin Province.This provides the necessity and urgency for the latter two parts of the study.Considering its strong toxicity and inability to be cleared,it is necessary to perform hemopurification.However,the conventional hemopurification scheme is relatively rigid,and a paraquat concentration detection technology is needed to provide guidance for the timing of hemoperfusion.The second part aims to verify the rationality of semi-quantitative determination of urinary paraquat concentration by sodium bisulfite detection method,so as to provide theoretical basis for its guidance of hemoperfusion.Based on the theoretical basis of the second part,the third part proposed a goal-oriented hemoperfusion scheme with the goal of fully removing the poison and the guidance of semi-quantitative urine concentration detection.By comparing with the routine hemopurification scheme,we discussed the superiority of the scheme in the treatment of paraquat poisoning.Part ?.Clinical Analysis of 1036 Casesof Acute Severe Poisoning ObjectiveThe aim of this study was to retrospectively analyze the epidemiological characteristics and prognostic factors of acute severe poisoning in Jilin Province,so as to provide reference for the treatment of acute severe poisoning.MethodsThe subjects were 1036 patients with acute severe poisoning who were admitted to intensive care units(ICU)(or corresponding departments)of 8 tertiary hospitals in Jilin Province from January 1,2018to December 31,2020.The information of patients was obtained through the self-made"Jilin Province Severe Poisoning Information Questionnaire".SPSS17.0 statistical software were used to analyze epidemiological characteristics of the 1036 patients,including age,gender,occupation,poisoning cause,poisoning type,poisoning route,and poisoning season.Univariate analysis and multivariate Logistic regression analysis were performed on the factors that might affect the prognosis of patients,such as cardiopulmonary resuscitation,mechanical ventilation,length of stay in ICU,toxicant class,and so on.The high risk toxicants were highlighted.ResultsA total of 1036 patients with acute severe poisoning were included.Among them,the ratio of male to female was 1:1.17,most of the patients were 20?39 years old(47.98%),farmer was the most common occupation(60.23%),suicide was the main cause of poisoning(87.64%),most of the patients were poisoned by digestive tract(93.05%),and the total fatality rate was 12.55%.The top three toxic substances were organophosphorus(159 cases,15.35%),sedative and hypnotic drugs(144 cases,13.90%),and paraquat(124 cases,11.97%).In general,pesticide poisoning was common.In terms of the month distribution,pesticide poisoning occurred mostly from April to September,mushroom poisoning occurred mostly from August to October,and carbon monoxide poisoning occurred from November to March.The incidence of multiple organ dysfunction syndrome(MODS)varied from 12.73%to 73.39%.The order of dysfunctional organ was brain(76.81%),lung(70.82%),circulatory system(55.36%),liver(49.63%),kidney(20.95%),blood coagulation system(13.22%),gastrointestinal system(9.98%),and metabolic system(9.48%).Univariate analysis showed that cardiopulmonary resuscitation,mechanical ventilation,type of toxicant,length of stay in ICU,time from poisoning to treatment,and Acute Physiology and Chronic Health Evaluation(APACHE?)were the factors with statistical differences(P<0.05).Multivariate Logistic regression analysis showed that cardiopulmonary resuscitation,mechanical ventilation,type of toxicant,length of stay in ICU and APACH?score were independent risk factors significantly related to prognosis(P<0.05).Conclusion1)Acute severe poisoning in Jilin Province has epidemiological characteristics related to agriculture.2)The incidence of MODS varies greatly among different acute severe poisonings;the organs with the highest incidence of dysfunction were the brain and lungs.3)Cardiopulmonary resuscitation,mechanical ventilation,type of toxicant,length of stay in ICU,APACHE-?score were independent risk factors significantly associated with prognosis.4)Paraquat poisoning was a common type with the highest incidence of MODS and fatality.Part ?.Dynamic Correlation between the Semi-Quantitative Value of Paraquat in Urine Determined by Sodium Hydrosulfite Method and Concentration of Paraquat in BloodObjectiveThis study aims to explore the dynamic correlation between the semi-quantitative value of urinary paraquat concentration measured by sodium hydrosulfite assay and the plasma paraquat concentration,so as to provide a theoretical basis for the clinical application of sodium hydrosulfite semi-quantitative assay.MethodsPatients with acute paraquat poisoning who were admitted to the emergency ICU of the First Hospital of Jilin University from January 1,2018 to July 31,2018 were selected as subjects.Blood and urine samples were continuously collected from each patient at admission and at the end of each hemoperfusion until the patient met one of the following conditions:1)the result of the semi-quantitative urine paraquat test turned negative;2)acute kidney injury occurred;3)poisoning time exceeded 24 h.A high performance liquid chromatographywas established for quantitative determination of paraquat concentration in plasma,and the concentration of paraquat in urine was determined semi-quantitatively by sodium hydrosulfite detection kit.Spearman correlation analysis was used to detect the correlation between blood and urine paraquat concentrations.ResultsAfter screening,a total of 18 poisoning patients were included in this study and61 blood and urine samples were collected.Correlation analysis showed that there was a significant correlation between the semi-quantitative detection value of paraquat in urine and the quantitative detection value of paraquat in plasma at the same time point within 24 h of poisoning under the premise of no acute kidney injury(r=0.975,P=0.000).ConclusionWithin 24 h of acute paraquat poisoning,for patients with normal renal function,the semi-quantitative value of urinary paraquat detected by sodium hydrosulfite method can reflect the degree of plasma paraquat load in real time.Part ?.Observation on the Therapeutic Effect of Goal-Oriented Hemoperfusion on Acute Paraquat PoisoningObjectiveThe purpose of this study was to explore the advantages of goal-oriented hemoperfusion in the treatment of acute paraquat poisoning.MethodsThis is abefore-and after-study of different cases.Patients with acute paraquat poisoning admitted to the emergency ICU of the First Hospital of Jilin University from August 1,2018 to March 31,2021,were selected as subjects:patients enrolled from August 1,2018 to December 31,2019 were divided into the routine group and given routine blood purification regimen,i.e.,twice blood perfusion+continuous renal replacement therapy(CRRT);patients enrolled from January 1,2020 to March31,2021 were divided into the goal-oriented group and given a goal-oriented hemoperfusion regimen,that is,the frequency and interval of hemoperfusion were determined by the semi-quantitative test results of urinary paraquat concentration,and the subsequent application of CRRT was determined according to the development of acute kidney injury.Patients in both groups received the same other routine treatment regimen(gastric lavage,adsorption,catharsis,antioxidant therapy,immunomodulatory therapy,respiratory support,and renal protection).Kaplan-Meier survival curve,X~2test,Fisher's exact test,and other statistical methods were used to compare the incidence of adverse events and prognosis of the two groups.ResultsA total of 64 patients with paraquat poisoning were included in this study after screening,including 25 cases in the goal-oriented group and 39 cases in the routine group.There was no statistical difference in the incidence of adverse reactions between the two groups(P=1.000).The 7-day fatality rate(32.00%)in the goal-oriented group was significantly lower than that in the routine group(58.97%),and the difference was statistically significant(P=0.035);the 28-day mortality rate(52.00%)in the goal-oriented group was still lower than that in the control group(66.67%),but the difference was not statistically significant(P=0.327);there was no significant difference in 28-day survival between the two groups after Log Rank test(P=0.129).Further stratified analysis showed that for patients with oral dose?40 ml,the 28-day fatality rate in the goal-oriented group was significantly lower than that in the control group(26.67%vs.58.62%,P=0.047).There was also significant difference in Kaplan-Meier survival curve between the two groups(P=0.046).There was no difference in 28-day fatality between the two groups(90.00%vs.90.00%)for patients with oral dose of(29)40 ml.ConclusionCompared with routine hemopurification regimens,goal-oriented hemoperfusion improved the efficacy of paraquat clearance and significantly improved the 28-day prognosis of patients with low oral dose(?40 ml).There was no significant difference in the safety of treatment between the two regimens. |
PDF Full Text Request