目的 探讨强化血液灌流联合甲泼尼龙琥珀酸钠冲击治疗对急性百草枯中毒患者肺纤维化及血清百草枯清除率的影响,并观察其临床疗效.方法 将本院2010年2月至2016年2月收治的58例急性百草枯中毒患者采用完全随机化方法分为试验组和对照组,两组患者均给予阻断毒物吸收、促进毒物排除等常规治疗,并给予强化血液灌流治疗,试验组患者在此基础上给予甲泼尼龙琥珀酸钠冲击治疗.绘制百草枯标准曲线,分别于治疗前(Tpre)、治疗后即刻(T0)、治疗后8小时(T8)、治疗后16小时(T16)采集患者静脉血以检测百草枯浓度,计算百草枯清除率.分别于治疗后1、3、7、14天采用高分辨率CT(high resolution computed tomography,HRCT)评分以及血清透明质酸(hyaluronic acid,HA)、基质金属蛋白酶9(matrix metalloproteinase-9,MMP-9)水平评估患者的肺纤维化程度,并比较两组患者的存活率.结果 T0时间点试验组患者百草枯清除率显著高于对照组(P<0.05),T8、T16时间点两组患者百草枯清除率比较均无显著差异(P>0.05);治疗后两组患者HRCT评分及HA、MMP-9水平均逐渐升高,试验组患者升高幅度显著低于对照组(P<0.05).试验组患者生存率显著高于对照组(P<0.05).结论 采用强化血液灌流联合甲泼尼龙琥珀酸钠冲击治疗能够显著提高急性百草枯中毒患者血清百草枯清除率,缓解肺纤维化程度,提高患者生存率.%Objective To investigate the effect of intensive hemoperfusion combined with methylpredn-isolone sodium succinate on pulmonary fibrosis and serum paraquat clearance in patients with acute paraquat poisoning, and to observe its clinical curative effect. Method 58 patients with acute paraquat poisoning from February 2010 to February 2016 in our hospital were divided into experimental group and control group by completely randomized method. Patients in both groups were treated with routine therapy, such as blockage of poison absorption and promotion of toxic excretion, and intensive hemoperfusion treatment, while experimental group patients were given methylprednisolone succinate treatment. Paraquat concentration was determined by before treatment (Tpre), immediately after treatment (T0), 8 hours after treatment (T8), 16 hours after treatment (T16) respectively to calculate the clearance. High-resolution computed tomography (HRCT) score and levels of serum hyaluronic acid (HA) and matrix metalloproteinase-9 (MMP-9) were used to assess the degree of pulmonary fibrosis in 1 day, 3 days, 7 days and 14 days after treatment. The survival rates of the two groups were compared. Result The clearance rate of T0 in experimental group was significantly higher than that in control group (P < 0.05), and there were no differences in T0 and T16 (P > 0.05). The HRCT score, levels of HA and MMP-9 of the two groups increased gradually after treatment, but experimental group increased slower (P < 0.05). The survival rate of experimental group was significantly higher than that of control group (P < 0.05). Conclusion The combination of intensive hemoperfusion and methylprednisolonesodium succinate can significantly improve the paraquat clearance rate, relieve the degree of pulmonary fibrosis and improve the survival rate of patients with acute paraquat poisoning. It is worthy of popularization and application.
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