Treatment Outcome of Combined Continuous Venovenous Hemofiltration and Hemoperfusion in Acute Paraquat Poisoning: A Prospective Controlled Trial
Treatment Outcome of Combined Continuous Venovenous Hemofiltration and Hemoperfusion in Acute Paraquat Poisoning: A Prospective Controlled Trial
复制标题
连续静脉血液滤过和血液灌流联合治疗急性百草枯中毒的治疗结果：一项前瞻性对照试验
DOI：
10.1097/ccm.0000000000002826
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发表时间：
2018-01-01
影响因子：
8.8
通讯作者：
Peng, Ai
中科院分区：
文献类型：
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作者：
Li, Changbin;Hu, Dayong;Peng, Ai
目的：探讨连续性静脉-静脉血液滤过联合血液灌流治疗百草枯中毒患者是否能提高生存率。设计：为期4年的前瞻性、对照性干预研究。设置：单一，三级，学术医疗中心。患者：我们招募了摄入百草枯后48小时内入住上海第十人民医院的患者。排除对象为14岁以下、与其他毒物一起摄入百草枯、孕妇、有慢性肺病、精神病、甲状腺机能亢进症或糖尿病伴肝或肾功能受损者。干预措施：所有患者均接受连续性静脉-静脉血液滤过联合血液灌流治疗（连续性静脉-静脉血液滤过组）和常规治疗（常规组）。研究结果是摄入百草枯后90天内任何原因导致的死亡，以及缺氧、急性肾损伤或不良事件的频率。测量和主要结果：在110例入组患者中，59例被分配至连续性静脉-静脉血液滤过组，51例被分配至常规组。两组具有相似的基线人口统计学和临床特征。在摄入百草枯后90天，连续性静脉-静脉血液滤过组59例患者中有19例（32.2%）死亡，常规组51例患者中有29例（56.9%）死亡（风险比，0.43; 95%CI，0.24 - 0.76; p = 0.004）。在控制基线特征的多变量考克斯比例风险模型中，与常规治疗相比，连续性静脉-静脉血液滤过和血液灌流联合治疗与死亡风险降低独立相关（校正风险比，0.35; 95% CI，0.19 - 0.64; p = 0.001）。与传统组相比，连续性静脉-静脉血液滤过组患者缺氧（40.7% vs 72.5%; p = 0.001）和急性肾损伤（59.3% vs 78.4%; p = 0.03）的发生率降低。低磷血症和血小板减少症在连续性静脉-静脉血液滤过组更常见（P <0.05）。结论：在百草枯中毒患者中，连续性静脉-静脉血液滤过和血液灌流联合治疗显著提高了90天生存率。
Objectives: To investigate whether combined continuous venovenous hemofiltration and hemoperfusion among paraquat-poisoned patients would improve survival. Design: Prospective, controlled interventional study over 4 years. Setting: Single, tertiary, academic medical center. Patients: We recruited patients admitted to Shanghai Tenth People’s Hospital within 48 hours after paraquat ingestion. Exclusions were under 14 years old, ingestion of paraquat with other toxicants, pregnant, a history of chronic pulmonary disease, psychosis, hyperthyroidism, or diabetes with impaired liver or renal function. Interventions: All patients were assigned to receive continuous venovenous hemofiltration with hemoperfusion therapy (continuous venovenous hemofiltration group) and to receive conventional therapy (conventional group). The study outcomes were death from any cause within 90 days after paraquat ingestion and the frequencies of hypoxia, acute kidney injury, or adverse events. Measurements and Main Results: Of the 110 enrolled patients, 59 were assigned to continuous venovenous hemofiltration group and 51 to conventional group. The two groups had similar baseline demographics and clinical features. At 90 days after paraquat ingestion, 19 of 59 patients (32.2%) in the continuous venovenous hemofiltration group and 29 of 51 patients (56.9%) in the conventional group had died (hazard ratio, 0.43; 95% CI, 0.24–0.76; p = 0.004). In multivariable Cox proportional hazard models controlling for baseline characteristics, combined continuous venovenous hemofiltration and hemoperfusion was independently associated with reduced risk of death compared with conventional therapy (adjusted hazard ratio, 0.35; 95% CI, 0.19–0.64; p = 0.001). Patients in the continuous venovenous hemofiltration group, as compared to the conventional group, had a reduced occurrence rate of hypoxia (40.7% vs 72.5%; p = 0.001) and of acute kidney injury (59.3% vs 78.4%; p = 0.03). Hypophosphatemia and thrombocytopenia were more common in the continuous venovenous hemofiltration group (p < 0.05). Conclusions: In patients with paraquat poisoning, treatment with combined continuous venovenous hemofiltration and hemoperfusion significantly improved 90-day survival rates.