摘要目的 探讨持续血浆灌流治疗对血浆中百草枯浓度(PPQ)的影响及清除作用.方法 采用前瞻性观察研究,选择本院中毒急救中心24 h内就诊的急性百草枯(PQ)中毒患者21例,均进行持续血浆灌流治疗,血流速度180 ml/min,血浆流量40 ml/min,每隔3h更换一个活性炭灌流器,于首次灌流前及更换灌流器后1.5h记录尿百草枯浓度(UPQ)、尿流速(UFR)、PPQ各1次,并计算肾脏和血浆灌流对PQ的清除速度.结果 21例患者共进行了108次血浆灌流治疗,持续血浆灌流中每次血浆灌流对PQ的清除速度(ml/min)均显著高于同时间段肾脏自身的PQ清除速度[第1次(21例)11.14±6.13比5.33±4.33,第2次(21例)18.36±11.32比4.85土3.15,第3次(21例)16.13土10.05比0.84±0.80,第4次(17例)12.86(6.72,17.47)比0.28(0.09,0.60),第5次(11例)14.12(10.48,35.20)比0.10(0.03,0.73),第6次(7例)16.47(11.82,20.69)比0.13(0.03,0.40),第7次(5例)13.33(9.71,18.75)比0.33(0.24,0.47),第8次(5例)11.27(9.21,16.02)比0.32(0.10,1.22),P＜0.05或P＜0.01]；血浆灌流对PQ的清除与PPQ呈负相关(r=-0.479 9,P＜0.000 1),肾脏对PQ的清除与PPQ呈正相关(r=0.506 0,P＜0.000 1).存活者(10例)PPQ的下降速度(mg·L-1·h-1)要高于死亡者(11例,0.57土0.03比0.47土0.06,P＜0.05).结论 持续血浆灌流治疗可以降低PPQ,可能是治疗PQ中毒的一个手段.

abstractsObjective To examine the impact of continuous plasma perfusion on plasma PQ concentra-tion (PPQ) in acute PQ-poisoning patients for the estimation of its PQ clearance effect.Methods 21 PQ- poisoned patients admitted to our poisoning center within 24 hours after the ingestion were prospectively enrolled.Continuous plasma perfusion (flow rate 180 ml/min) was performed,with plasma/blood separation at 40 ml/min and routine cartridges change every 3 hours.Urinary PQ (UPQ),urine flow rate (UFR),and PPQ level at inlet/outlet of the cartridge were obtained right before,and l.5 hours after the start of each perfusion session for calculation of renal and plasma PQ excretion.Results In all 8 rounds (108 sessions) of plasma perfusion on the 21 patients,PQ elimination rate (ml/min) by plasma perfusion was found always higher than the renal value:Clst (21 cases) 11.14+6.13 vs.5.33± 4.33; 2nd (21 cases) 18.36土11.32 vs.4.85土3.15; 3rd (21 cases) 16.13+10.05 vs.0.84士0.80; 4th (17 cases) 12.86 (6.72,17.47) vs.0.28 (0.09,0.60); 5th (11 cases) 14.12 (10.48,35.20) vs.0.10 (0.03,0.73); 6th (7 cases) 16.47 (11.82; 20.69) vs.0.13 (0.03,0.40); 7th (5 cases) 13.33 (9.71,18.75) vs.0.33 (0.24,0.47); 8th (5 cases) 11.27 (9.21,16.02) vs.0.32 (0.10,1.22),P < 0.05 0r P < 0.011.In the study,PPQ was found negatively correlated to PQ elimination by plasma perfusion (r=- 0.479 9,P<O.000 1),and positively correlated to the renal elimination (r= 0.506 0,P< 0.000 1).The survivors (10 cases) showed a higher PPQ reduction rate (mg.L l.H-l) than the non-survivors (11 cases,0.57士 0.03 vs.0.47土0.06,P< 0.05).Conclusion Continuous plasma perfusion may be a promising therapeutic tool for its significant PPQ reduction effect,and plasma perfusion should be made available early for patients with acute PQ intoxication.