肾脏与连续血浆灌流清除百草枯的比较。

Comparison between kidney and continuous plasma perfusion for paraquat elimination.

机构信息

Graduate School of Tianjin Medical University (G-QL), Tianjin, China; and Departments of Intensive Care Medicine (G-QL, L-QW, YL, Y-HZ), Department of Cardiology (Y-ML), Affiliated Hospital of the Medical College of the Chinese People's Armed Police Forces, Tianjin, China.

出版信息

Am J Med Sci. 2014 Sep;348(3):195-203. doi: 10.1097/MAJ.0000000000000235.

DOI:10.1097/MAJ.0000000000000235

PMID:24743403

Abstract

BACKGROUND

Thousands of paraquat (PQ)-poisoned patients continue to die. Plasma perfusion (PP) has recently been incorporated as a method of clinical detoxification. The purpose of this study was to estimate the PQ clearance of PP and observe the effect of PP on PQ concentration in the blood of patients with acute PQ poisoning.

METHODS

Twenty one PQ-poisoned patients admitted to our poisoning center within 24 hours after the ingestion were prospectively enrolled. Continuous plasma perfusion was performed. Urinary PQ and plasma PQ concentration level at inlet/outlet of the cartridge were obtained right before and 1.5 hours after the start of each perfusion session for the calculation of renal and plasma PQ excretion.

RESULTS

In all 8 rounds (108 sessions) of PP on the 21 patients, PQ clearance rate (mL/min) by PP was always found to be higher than the renal value: (1st 11.14 ± 6.13 versus 6.53 ± 1.46; 2nd 18.36 ± 11.32 versus 6.23 ± 1.51; 3rd 16.13 ± 10.05 versus 4.01 ± 0.93; 4th 12.86 [6.72, 17.47] versus 2.42 [0.65, 4.20]; 5th 14.12 [10.48, 35.20] versus 1.77 [0.63, 2.91]; 6th 16.47 [11.82; 20.69] versus 1.70 [0.23, 3.18]; 7th 13.33 [9.71, 18.75] versus 1.10 [0.14, 2.99]; 8th 11.27 [9.21, 16.02] versus 1.10 [0.09, 2.79], P < 0.05). The survivors showed a higher plasma PQ reduction rate (mg L hour) than the nonsurvivors (0.57 ± 0.03 versus 0.47 ± 0.06, P < 0.05).

CONCLUSIONS

Our data show that PP therapies help in the clearance of PQ and may prove a promising therapeutic tool in patients with acute PQ intoxication.

摘要

背景

仍有数千例百草枯（PQ）中毒患者死亡。血浆灌流（PP）最近已被纳入临床解毒方法。本研究旨在评估 PP 对 PQ 的清除率，并观察 PP 对急性 PQ 中毒患者血液中 PQ 浓度的影响。

方法

前瞻性纳入 21 例在摄入后 24 小时内被送入我们中毒中心的 PQ 中毒患者。连续进行血浆灌流。在每次灌流开始前和开始后 1.5 小时，获取灌流器入口/出口处的尿 PQ 和血浆 PQ 浓度水平，以计算肾和血浆 PQ 的排泄量。

结果

在 21 例患者的 8 轮（108 次）PP 中，PP 的 PQ 清除率（mL/min）始终高于肾值：（第 1 轮 11.14 ± 6.13 比 6.53 ± 1.46；第 2 轮 18.36 ± 11.32 比 6.23 ± 1.51；第 3 轮 16.13 ± 10.05 比 4.01 ± 0.93；第 4 轮 12.86[6.72，17.47] 比 2.42[0.65，4.20]；第 5 轮 14.12[10.48，35.20] 比 1.77[0.63，2.91]；第 6 轮 16.47[11.82；20.69] 比 1.70[0.23，3.18]；第 7 轮 13.33[9.71，18.75] 比 1.10[0.14，2.99]；第 8 轮 11.27[9.21，16.02] 比 1.10[0.09，2.79]，P < 0.05）。幸存者的血浆 PQ 下降率（mg·L·小时）高于非幸存者（0.57 ± 0.03 比 0.47 ± 0.06，P < 0.05）。