Failure of continuous venovenous hemofiltration to prevent death in paraquat poisoning
Failure of continuous venovenous hemofiltration to prevent death in paraquat poisoning
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DOI：
10.1053/ajkd.2002.29880
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发表时间：
2002-01-01
影响因子：
13.2
通讯作者：
Noh, JW
中科院分区：
文献类型：
--
作者：
Koo, JR;Kim, JC;Noh, JW
百草枯中毒的特点是多器官功能衰竭和肺纤维化伴呼吸衰竭。多器官衰竭伴循环衰竭是摄入百草枯后3天内过早死亡的主要原因。最近的研究表明，连续性静脉-静脉血液滤过（CVVH）通过促进血流动力学稳定在治疗多器官衰竭中发挥作用。因此，我们评价了80例百草枯中毒患者（1996年8月至1999年2月）预防性CVVH的效果。摄入量为2.1 +/-1.0口（20%浓缩物）。所有患者均在摄入后24小时内接受了血液灌注（HP;持续时间，6.4 +/-3.0小时）治疗，然后随机分配至单独HP组或HP-CVVH组。44例患者仅接受HIP，36例患者在HIP后接受CVVH（持续时间，57.4 ± 31.3小时;超滤量，40.2 ± 4.8 L/d）。尽管HP-CVVH组摄入后至死亡的时间显著长于HP组（5.0 +/-5.0 vs 2.5 +/-2.1天; P <0.05），但两组之间的死亡率无差异（66.7% vs 63.6%; P = 0.82）。在HIP组中，早期循环衰竭是死亡的主要原因，而HP-CVVH组中晚期呼吸衰竭是死亡的主要原因。总之，HP后预防性CVVH可预防循环衰竭引起的早期死亡，并延长生存时间。然而，它不能预防呼吸衰竭造成的晚期死亡，也不能为急性百草枯中毒患者提供生存益处。(C)2002年，美国国家肾脏基金会（National Kidney Foundation，Inc.）
Paraquat poisoning is characterized by multiorgan failure and pulmonary fibrosis with respiratory failure. Multiorgan failure with circulatory collapse is a major cause of early death within 3 days of paraquat ingestion. Recent studies suggested that continuous venovenous hernofiltration (CVVH) had a role in the treatment of multiorgan failure by promoting hemodynamic stability. We therefore evaluated the effect of prophylactic CVVH in 80 patients with paraquat poisoning (August 1996 to February 1999). The amount ingested was 2.1 +/- 1.0 mouthfuls (as 20% concentrate). All patients were treated with hernoperfusion (HP; duration, 6.4 +/- 3.0 hours) within 24 hours of ingestion and then randomly assigned to the HP-alone or HP-CVVH group. Forty-four patients underwent HIP only, and 36 patients underwent CVVH (duration, 57.4 +/- 31.3 hours; ultrafiltration volume, 40.2 +/- 4.8 L/d) after HIP. Although time to death after ingestion was significantly longer in the HP-CVVH than HP group (5.0 +/- 5.0 versus 2.5 +/- 2.1 days; P < 0.05), there was no difference in mortality rates between the two groups (66.7% versus 63.6%; P = 0.82). In the HIP group, early circulatory collapse was a major cause of death compared with the HP-CVVH group, in which late respiratory failure was a major cause of death. In conclusion, prophylactic CVVH after HP prevented early death caused by circulatory collapse and prolonged survival time. However, it could not prevent late death caused by respiratory failure and did not provide a survival benefit in acute paraquat poisoning. (C) 2002 by the National Kidney Foundation, Inc.