Clinical Observation of Continuous Veno-Venous Hemofiltration Combined with Hemoperfusion in The Treatment of Severe Acute Organophosphorus Poisoning
Objective:To observe the clinical efficacy of continuous veno-venous hemofiltration(CV-VH)combined with hemoperfusion(HP)in the treatment of severe acute organophosphorus poisoning(ASOPP).Methods:The data of 126 patients with ASOPP were retrospectively analyzed.According to the treatment methods,the patients were divided into CVVH+HP group(n=60)and HP group(n=66).The ef-ficacy and treatment were observed.Serum cholinesterase(CHE)level was recorded before treatment(T1)and at 4h(T2),24h(T3)and 72h(T4)after treatment.The differences of serum inflammatory factors[in-terleukin-1β(IL-1β),interleukin-6(IL-6),interleukin-10(IL-10),tumor necrosis factor-α(TNF-α)]and liver-kidney injury related indicators[cystatin C(CysC),prealbumin(PA),high mobility group protein B1(HMGB1)]were compared between the two groups at T1 and T3,and the occurrence of complica-tions was observed.Results:The cure rate was 93.33%in CVVH+HP group,which was higher than 78.79%in HP group(P<0.05).There was no statistical significance in the incidence rate of rebound between the two groups(P>0.05).The dosages of atropine and pralidoxime chloride with(143.37±18.72)mg and(10.28±2.62)g in CVVH+HP group were less than(154.18±21.47)mg and(19.57±4.31)g in HP group(all P<0.05).The coma time and hospital stay in CVVH+HP group were(13.38±3.41)h and(7.26±1.58)d,which were shorter than(22.15±4.14)h and(8.42±1.74)d in HP group(all P<0.05).At T2～T4,the level of serum CHE in the two groups was increased gradually,and the increase in CVVH+HP group was greater than that in HP group(all P<0.05).At T1,the levels of serum IL-1β,IL-6,IL-10 and TNF-α and serum CysC,PA and HMGB1 revealed no statistical differences between the two groups(P>0.05).The differences of serum IL-1β,IL-6,IL-10,TNF-α,CysC,PA and HMGB1 at T1-T3 were greater in CVVH+HP group than those in HP group(all P<0.05).There was no statistical difference in the occurrence of complications between the two groups(P>0.05).Conclusion:Compared with HP alone,CVVH+HP for ASOPP can enhance the cure rate,improve the treatment,promote the recovery of serum CHE activity,allevi-ate the inflammatory response and relieve the organ damage,and it has good safety and certain advantages.
万方数据
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