Analysis of the application effect of hemoperfusion combined with continuous hemodialysis in patients with acute organophosphorus pesticide poisoning
Objective To observe the effects of hemoperfusion(HP)combined with hemodialysis on cholinesterase(ChE)activity and inflammatory factors in patients with acute organophosphorus pesticide poisoning(AOPP).Methods A retrospective cohort study was conducted.Seventy-three AOPP patients admitted to the department of emergency of Yingshang People's Hospital from January 2020 to December 2022 were enrolled.The patients were divided into HP group(31 cases)and HP+continuous renal replacement therapy(CRRT)group(42 cases)according to different treatment regimens.All patients were given supportive treatment according to the standard protocol after admission.HP was given to the patients as soon as possible after admission,and the treatment time was between 2 hours and 3 hours,with an interval of 24 hours.Patients in HP+CRRT group were treated with continuous veno-venous hemodiafiltration(CVVHDF)after HP.The serum ChE,tumor necrosis factor-α(TNF-α),and interleukins(IL-1,IL-6)levels were compared between the two groups after admission(T0),at the end of the first HP/HP+CRRT(T1),at the end of the second HP/HP+CRRT(T2),and at the end of the third HP/HP+CRRT(T3).The ChE recovery time,the incidence of intermediate syndrome(IMS),the length of hospital stay,and the rate of admission to ICU were also compared.Results With the extension of treatment time,the ChE activity at T1,T2,and T3 in the two groups was significantly higher than that at T0,and the levels of TNF-α,IL-1,and IL-6 were significantly lower than those at T0,reaching the trough value at T3,and the changes in HP+CRRT group were more significant than those in HP group[ChE activity(U/L):2 903.26±164.43 vs.2 292.98±350.96,TNF-α(ng/L):78.24±10.75 vs.100.55±15.58,IL-1(ng/L):95.98±22.56 vs.127.94±18.74,IL-6(ng/L):34.36±8.66 vs.58.74±10.46,all P<0.05].The recovery time of ChE activity and length of hospital stay in HP+CRRT group were significantly shorter than those in HP group[ChE activity recovery time(days):4.42±1.17 vs.7.31±1.46,length of hospital stay(days):9.25±2.14 vs.12.75±2.30,both P<0.05],the incidence of IMS and ICU admission rate were significantly lower than those in HP group[the incidence of IMS:33.33%(14/42)vs.61.29%(19/31),ICU admission rate:9.52%(4/42)vs.29.03%(9/31),both P<0.05].Conclusion For AOPP patients,HP+CRRT is superior to HP alone in the clearance of inflammatory factors,restoring ChE activity,reducing the incidence of IMS,and shortening the length of hospital stay,making it a valuable option for clinical application.
HemoperfusionContinuous renal replacement therapyAcute organophosphorus pesticide poisoningAnalysis of efficacy
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