| BackgroundAcute pesticide poisoning is one of the major diseases that endanger human life and health.At present,most pesticides have no special antidote or the effect is uncertain,and the treatment measures mainly take remove toxic pesticides and symptomatic supports.Hemoperfusion is the most commonly used blood purification method to remove toxic pesticides that have been absorbed.However,anticoagulation is an important basis to ensure the progress of hemoperfusion.Unfractionated heparin is the most commonly used anticoagulant for hemoperfusion,with fast onset,fast metabolism,cheap price and corresponding antagonist protamine,but there is no uniform standard dose so far.ObjectiveTo study the effects of different doses of initial unfractionated heparin on the incidence of body bleeding,coagulation of perfusion flow and pipeline in patients.To analyze the changes of blood coagulation function,the changes of platelets and recovery process before and after perfusion in each group.To explore the risk factors of coagulation and bleeding in perfusion and pipeline.All in all,so as to provide reference for how to apply more reasonable dose of unfractionated heparin in the future.MethodsAccording to the initial dose of unfractionated heparin,three groups were set as controls.Group A was 0.5 mg/kg,group B was 0.8 mg/kg,group C was 1.0 mg/kg at initial,all the patients were maintained 5 mg per half hour.Using the formula method to estimate the sample size of each group.The patients with acute pesticide poisoning who met the hemoperfusion treatment in our hospital from January 2018 to December 2019,were randomly distributed to each group.First of all,to compare the incidence of hemorrhage and thrombin.Furthermore,analysis the changes of blood coagulation function before and after hemoperfusion,the changes of platelets and recovery process before and after perfusion in each group.In addition,the risk factors affecting hemorrhage were analyzed by logistic regression analysis,and the receiver operating characteristic curves was drawn to evaluate its predictive value.ResultsA total of 180 eligible patients(97 males and 83 females,average age is 45.11±17.03years)were included in this study.There were 59 patients in group A,61 patients in group B and 60 patients in group C.(1)There were 11 cases of coagulation in the three groups,the total coagulation rate was 6.1%.The thrombosis rate of group A was 13.6%,group B was 3.3%,group C was1.7%.There was statistical difference among this three groups(P<0.05).The difference between group A and B was statistically significant(P<0.05),and there was no statistical difference between group B and C.(2)There were 14 cases of body hemorrhage in three groups,the total bleeding rate was 7.8%.The hemorrhage of group A was 1.7%,group B was 4.9%,group C was 16.9%.There was statistical difference among this three groups(P<0.05).There was no statistical difference between the group A and B,but there was a statistically significant difference between the group B and C(P<0.05).(3)The FIB 、 FDP 、 D＿D of group A was significantly higher than that before irrigation(P<0.05),and no significant change was found in group B and C.The PT、INR、APTT 、 TT of group B and C were significantly longer than those before irrigation(P<0.05),and there was no significant change in group A.(4)Platelets decreased significantly in all groups after perfusion(P<0.05),but with no significant difference between the three groups.Platelets in each group recovered to pre-infusion levels 24～48 h after perfusion.(5)The unfractionated heparin and APTT are independent risk factors for bleeding in patients.The unfractionated heparin and D＿D are independent risk factors for coagulation in perfusion apparatus and pipeline.ConclusionIn the process of acute pesticide poisoning with hemoperfusion,unfractionated heparin is the main risk factor that affects the coagulation and hemorrhage.The choice of unfractionated heparin with initial dose 0.8 mg/kg and maintenance dose 5 mg/0.5h,can not only effectively reduce the risk of body bleeding during hemoperfusion,but also prevent the coagulation risk of perfusion flow and pipeline. |
PDF Full Text Request