The Clinical Study On The Treatment Of Acute And Severe Organophosphate Pesticide Poisoning Was Carried Out By Hemoperfusion Combined With Continuous Veno-venous Hemodiafiltration

Objective: To observe the clinical effects of hemoperfusion combined with continuous veno-venous hemodiafiltration on treating acute severe organophosphorus pesticide poisoning.Methods: 63 cases of acute severe organophosphorus pesticide poisoning treated by the ICU of Hanting District People's Hospital between January.2014 and October.2016 were selected,29 male and female 34 in cases,aged 14-70,divided into the study group(HP+CVVHDF group,33 cases)and the control group(HP group,30 cases).All the patients of two groups were offered gastric lavage,catharsis,rehydration diuretic,Cholinesterase Reactivators(pralidoxime chloride),muscarinic receptor antagonist(atropine or penehyclidine hydrochloride)after they were hospitalized,also they were received the other symptomatic and supportive treatment including fluid replacement,protecting multiple organ function and so on.The control group were offered the treatment of hemoperfusion as soon as possible after admission,the treatment time was about 2-3 hours.The study group were offered continuous veno-venous hemodiafiltration on the basis of the control group.While the treatment of hemoperfusion was taken 2-3 hours,interrupt the treatment and take down the perfusion apparatus,continue the continuous veno-venous hemodiafiltration in total 24-48 hours.Although the treatment of hemoperfusion can clear away the organophosphorus pesticide in a short time,the patients' internal environment were often in disorder,aggravate the encephaledema and the other organs' damage.But the continuous veno-venous hemodiafiltration scarcely change the patients' plasma colloid osmotic pressure,the hemodynamic is very stability,also it can regulate the patients' blood volume and keep the acid base and electrolyte balance.The continuous veno-venous hemodiafiltration can clear away the organophosphorus pesticide continuely and effectively and avoid the organophosphorus pesticide bouncing in blood,also it can clear away the inflammatory mediators with avoiding irreversible multiple organ tissue damage,but in general it isconsidered to need high cost.In this study taking the blood purification method of hemoperfusion combined with continuous veno-venous hemodiafiltration exactly is aimed at taking advantage of complementary to each other.Observe the two groups' medical economic parameters including coma time,mechanical ventilation time,serum levels of inflammatory factors including tumor necrosis factor-?,interleukin-1 ?,interleukin-6 and interleukin-8,the average number of days in the ICU,the average medical cost in the ICU and the clinical cure rate.Results: Between the two groups of coma time,mechanical ventilation time,clinical cure rate,the average number of days in the ICU,the average medical cost in the ICU in comparison,the difference was statistically significant(p<0.05).There were significant differences in the serum inflammatory factors including tumor necrosis factor-?,interleukin-1 ?,interleukin-6 and interleukin-8 levels in two groups after treatment.These cytokines serum levels were declined after treatment in two groups(p<0.05),and were lower in the study group than those in the control group(p<0.05).Conclusion:The Hemoperfusion combined with continuous veno-venous hemodiafiltration on treating acute severe organophosphorus pesticide poisoning have special advantage in removing serum inflammatory factors,can shorten the coma time and mechanical ventilation time,improve clinical cure rate,reduce the average number of days and the average medical cost in the ICU.In brief,Hemoperfusion combined with continuous veno-venous hemodiafiltration have the significant therapeutic effect and it is a safe,economical and effective hybrid blood purification method.