摘要
目的 探讨枸橼酸体外抗凝强化血液灌流治疗急性百草枯中毒的临床疗效.方法 急性百草枯中毒患者46例,在常规治疗基础上,体外抗凝组21例,使用枸橼酸抗凝,以枸橼酸根20.3～25.9 mmol/h的初始速度经血液灌流管路动脉端输入,而经静脉端输入葡萄糖酸钙3.3 mmol/h,根据灌流器及血清iCa2＋浓度调整枸橼酸和钙剂输注速度,每2 h更换一个灌流器,每次治疗6 h,使用3个灌流器.常规抗凝组25例,应用常规肝素抗凝强化血液灌流4 h,使用2个灌流器.监测灌流器前压、血流量、凝血相关指标、并发出血情况及血清iCa2＋等离子、酸碱指标.结果 体外抗凝组灌流器前压稳定于120 mm Hg左右,显著低于常规抗凝组（P＜0.01）.体外抗凝组血流量稳定于200 mL/min,显著低于常规抗凝组（P＜0.01）.两组凝血功能指标治疗前比较差异无统计学意义（P＞0.05）;治疗后常规抗凝组较体外抗凝组血小板显著减低（P＜0.05）,APTT显著延长（P＜0.01）.体外抗凝组较常规抗凝组并发出血发生率显著减少（P＜0.01）.体外抗凝组治疗前后无离子紊乱,酸碱指标比较差异也无统计学意义（P＞0.05）,未出现低血钙、高血钙、代谢性碱中毒等并发症.两组患者15 d及3个月转归比较差异有统计学意义（P＜0.05,P＜0.01）,体外抗凝组较常规抗凝组死亡率降低.结论 枸橼酸体外抗凝强化血液灌流技术,血路压力及血流量稳定,具有可行性、安全性、提高治愈率等优势,在救治急性百草枯中毒中有较为广阔的应用前景.
Objective To investigate the clinical effects of extracorporeal citrate antieoagulation by intensive hemoperfusion in acute paraquat poisoning. Methods Forty -six patients with acute paraquat poisoning were involved in our study, twenty - one cases with extracorporeal citrate anticoagulation based on the conventional treatment, the initial velocity of blood perfusion was 20.3 - 25.9 mmol/h with citric acid root inputted the arterial line, and was 3.3 mmol/h with calcium gluconate inputted the venous line. To adjust the infusion speed of citrate and calcium according to perfusion exporting and serum ionized calcium subsequently. Each treatment was six hours in need of replacement per two - hour perfusion. Twenty - five cases of conventional anticoagulation accepted the intensive hemoperfusion with conventional heparin for four hours and used two perfusions. The monitoring indicators included perfusion pressure before, blood flow, coagulation- related indicators, concurrent bleeding, ionized calcium and acid - base balance. Results Perfnsion pressure before was significantly lower in extracorporeal citrate anticoagulation group than in the conventional group, and was maintained around 120 mm Hg （ P 〈 0. 01）. The blood flow was kept around 200 mL/min and was lower in extracorporeal citrate anticoagulation group （ P 〈 0. 01 ）. Coagulation parameters between two groups before the treatment had no significant differences （P 〉 0. 05 ）. After the different treatments, the number of platelets was lower （P 〈 0.05 ） , activated partial thromboplastin time （APTF） was prolonged significantly （P 〈 0. 01 ） in conventional treatment group compared with extracorporeal group. The concurrent bleeding rate of two groups was 9.5% versus 76.0% （P 〈 0. 01 ）. Comparison before and after treatment in extracorporeal group, electrolyte disturbances bad no statistical differences （P 〉 0. 05）. The hypocalcemia, hypercalcemia, metabolic alkalosis and other complications were not existed. The comparisons of sequelae had significant differences between two groups of patients at 15th day and 3rd month （P 〈0.05 and P 〈0.01 ）. The mortality in extracorporeal citrate antieoagulation group was lower. Conclusion The advantages of treatment by extracorporeal citrate anticoagulation in intensive hemoperfusion are the stability of blood pressure and flow, feasibility, safety, improvement of cure rate, and have more broad application prospects in acute paraquat poisoning.
出处
《中国急救医学》
CAS
CSCD
北大核心
2011年第5期437-440,共4页
Chinese Journal of Critical Care Medicine
基金
吉林市科技发展计划资助项目（No.201032218）
关键词
枸橼酸体外抗凝
血液灌流
百草枯中毒
Extracorporeal citrate anticoagulation
Hemoperfusion
Paraquat poisoning
