Evaluation of hemoperfusion and continuous renal replacement therapy in paraquat poisoning patients complicated with MODS

doi:10.3969/j.issn.1004-583X.2023.04.007

Abstract

Abstract:

Objective To investigate the efficacy of hemoperfusion (HP) and continuous renal replacement therapy (CRRT) in paraquat (PQ) poisoning patients complicated with multiple organ dysfunction syndrome (MODS). Methods A total of 56 acute PQ poisoning patients complicated with MODS who received treatment from January 2019 to January 2022 were enrolled and retrospectively analyzed, including 27 patients treated with HP and 29 patients treated with HP+CRRT. The liver and kidney function, blood gas analysis, MODS score and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score before and after treatment were compared between the two groups. Kaplan Meier survival analysis was used to compare the survival rates of different treatment methods. Results There was no significant difference in blood biochemistry, blood gas analysis parameters, MODS and sequential organ failure assessment (SOFA) scores between the two groups before treatment (P>0.05). After treatment, alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), serum creatinine (Scr), prothrombin time (PT), prothrombin activity (PA), total bilirubin (TBil) Direct bilirubin (DBil), creatine kinase isoenzymes (CKMB), partial pressure of carbon dioxide (PaCO₂), alveolar arterial oxygen pressure difference (P (A-a) O₂), MODS and SOFA scores in the two groups were significantly lower than those before treatment (P<0.05). However, PH value, partial pressure of oxygen (PaO₂), bicarbonate ( $HCO 3 -$ ) and oxygenation index (PaO₂/FiO₂, P/F) were higher than those before treatment, and HP+CRRT group improved more significantly than HP group (P<0.05). The total mortality rate of 56 patients was 44.64%, which was higher in HP group than HP+CRRT group. Meanwhile, the survival curve showed that the survival rate of HP+CRRT group was obviously higher (P<0.05). Conclusion The combination of HP and CRRT can alleviate organ damage and reduce the mortality of PQ patients with MODS, making it an effective treatment therapy.

Key words: continuous renal replacement therapy, hemoperfusion, paraquat poisoning, multiple organ dysfunction syndrome

CLC Number:

R459.5

Tao Yang, Pan Qingquan, Li Yan. Evaluation of hemoperfusion and continuous renal replacement therapy in paraquat poisoning patients complicated with MODS[J]. Clinical Focus, 2023, 38(4): 330-334.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.04.007

https://huicui.hebmu.edu.cn/EN/Y2023/V38/I4/330

Figures/Tables 6

Tab. 1 Comparison of general clinical data between the two groups

变量	HP(n=27)	HP+CRRT(n=29)	t/χ²值	P值
年龄(岁)	35.41±12.33	36.72±13.23	0.383	0.704
男/女	15/12	12/17	1.125	0.289
入院时间(h)	7.35±3.64	7.82±4.74	0.414	0.681
呼吸衰竭[例(%)]	18(66.67)	19(65.52)	0.008	0.928
心力衰竭[例(%)]	13(48.15)	12(41.38)	0.259	0.611
急性胰腺炎[例(%)]	8(29.63)	7(24.14)	0.215	0.643
急性肝损伤[例(%)]	10(37.04)	12(41.38)	0.111	0.740
急性肾损伤[例(%)]	12(44.44)	14(48.28)	0.083	0.774
凝血功能障碍[例(%)]	3(11.11)	2(6.90)	0.305	0.580
横纹肌溶解[例(%)]	7(25.93)	9(31.03)	0.179	0.672
百草枯浓度(ng/ml)	1657.91±723.38	1629.37±714.51	0.148	0.883
中毒至就诊时间(h)	1.95±0.83	1.82±0.88	0.568	0.573
首次洗胃时间(h)	2.56±1.34	2.82±1.47	0.690	0.493
首次HP/CRRT/HP+CRRT时间(h)	15.67±2.38	15.72±1.45	0.096	0.924
HP/HP+CRRT治疗次数	8.37±1.46	6.15±1.79	5.063	<0.001
住院时间(d)	15.43±4.71	15.52±4.78	0.071	0.944

Tab. 2 Comparison of liver and kidney function indexes between the two groups ($\bar{x} \pm s$)

组别	例数	ALT(U/L)				AST(U/L)				BUN(U/L)				Scr(U/L)				PT(s)
组别	例数	治疗前		治疗后		治疗前		治疗后		治疗前		治疗后		治疗前		治疗后		治疗前		治疗后
HP	27	267.31±131.46		181.74±72.34^*		248.63±75.58		171.46±73.41^*		23.52±6.59		13.53±6.62^*		374.24±133.26		280.31±134.34^*		17.63±5.23		15.42±3.78^*
HP+CRRT	29	264.63±128.46		99.34±53.76^*		253.51±80.45		90.54±34.26^*		23.56±5.17		7.31±3.11^*		379.56±118.46		127.43±74.17^*		17.79±4.45		13.39±2.27^*
t值		0.077		4.861		0.233		5.346		0.025		4.551		0.158		5.321		0.124		2.456
P值		0.939		<0.001		0.817		<0.001		0.980		<0.001		0.875		<0.001		0.902		0.017
组别	TBil(mmol/L)				DBil(mmol/L)				IBil(mmol/L)				CKMB(U/L)				PA(%)
组别	治疗前		治疗后		治疗前		治疗后		治疗前		治疗后		治疗前		治疗后		治疗前		治疗后
HP	58.65±24.56		39.59±12.35^*		37.41±13.32		25.65±12.52^*		12.64±5.47		12.88±5.35		18.57±7.41		16.46±6.23^*		62.15±12.41		70.48±12.24^*
HP+CRRT	57.53±33.82		28.45±10.63^*		36.67±12.34		15.65±8.35^*		12.36±6.12		12.65±6.47		18.64±8.27		13.48±3.53^*		61.41±10.71		81.12±11.49^*
t值	0.141		3.625		0.216		3.539		0.180		0.144		0.033		2.222		0.239		3.355
P值	0.888		0.001		0.830		0.001		0.858		0.886		0.974		0.030		0.812		0.001

Tab. 3 Comparison of respiratory function indexes between the two groups ($\bar{x} \pm s$)

组别	例数		pH值(mmHg)				PaO₂(mmHg)				PaCO₂(mmHg)
组别	例数		治疗前		治疗后		治疗前		治疗后		治疗前	治疗后
HP	27		7.21±0.16		7.32±0.13^*		90.58±11.32		112.42±30.41^*		46.02±13.99	38.32±11.75^*
HP+CRRT	29		7.24±0.15		7.44±0.17^*		90.14±10.42		131.64±31.32^*		45.82±11.94	31.50±10.84^*
t值			0.724		2.951		0.151		2.327		0.058	2.259
P值			0.472		0.005		0.880		0.024		0.954	0.028
组别		$HCO 3 -$ (mmol/L)				P/F(mmHg)				P(A-a)O₂(mmHg)
组别		治疗前		治疗后		治疗前		治疗后		治疗前		治疗后
HP		17.19±3.14		20.51±2.99^*		76.27±24.61		310.56±95.39^*		348.53±64.89		261.93±38.77^*
HP+CRRT		18.45±3.93		24.72±2.26^*		75.39±22.85		382.41±97.64^*		337.81±67.33		183.21±36.75^*
t值		0.272		5.970		0.139		2.782		0.606		7.800
P值		0.786		<0.001		0.890		0.007		0.547		<0.001

Tab. 3 Comparison of respiratory function indexes between the two groups ($\bar{x} \pm s$)

组别	例数		pH值(mmHg)				PaO₂(mmHg)				PaCO₂(mmHg)
组别	例数		治疗前		治疗后		治疗前		治疗后		治疗前	治疗后
HP	27		7.21±0.16		7.32±0.13^*		90.58±11.32		112.42±30.41^*		46.02±13.99	38.32±11.75^*
HP+CRRT	29		7.24±0.15		7.44±0.17^*		90.14±10.42		131.64±31.32^*		45.82±11.94	31.50±10.84^*
t值			0.724		2.951		0.151		2.327		0.058	2.259
P值			0.472		0.005		0.880		0.024		0.954	0.028
组别		$HCO 3 -$ (mmol/L)				P/F(mmHg)				P(A-a)O₂(mmHg)
组别		治疗前		治疗后		治疗前		治疗后		治疗前		治疗后
HP		17.19±3.14		20.51±2.99^*		76.27±24.61		310.56±95.39^*		348.53±64.89		261.93±38.77^*
HP+CRRT		18.45±3.93		24.72±2.26^*		75.39±22.85		382.41±97.64^*		337.81±67.33		183.21±36.75^*
t值		0.272		5.970		0.139		2.782		0.606		7.800
P值		0.786		<0.001		0.890		0.007		0.547		<0.001

Tab. 4 Comparison of MODS scores and SOFA scores between the two groups ($\bar{x} \pm s$)

组别	例数	MODS评分(分)		SOFA评分
组别	例数	治疗前	治疗后	治疗前	治疗后
HP	27	5.19±2.40	3.14±1.53^*	14.31±3.29	11.58±2.97^*
HP+CRRT	29	5.47±2.52	2.15±0.92^*	14.61±4.67	8.23±1.84^*
t值		0.425	2.958	0.276	5.029
P值		0.672	0.005	0.784	<0.001

Tab. 5 Comparison of death time and mortality between the two groups [cases (%)]

组别	例数	死亡率
组别	例数	10天	10~30天	合计
HP	27	7(25.93)	9(33.33)	16(59.26)
HP+CRRT	29	1(3.45)	8(27.59)	9(31.03)
χ²值		5.769	0.218	4.507
P值		0.016	0.640	0.034

Fig. 1 Comparison of survival curve between the two groups

References 18

[1]	李哲, 郑艾宜. 急性百草枯中毒患者长期预后的研究进展[J]. 重庆医学, 2022, 51(17):3025-3028, 3033.
[2]	曹钰, 蒋臻. “后百草枯时代”除草剂中毒的现状与研究进展[J]. 西部医学, 2021, 33(12):1717-1720.
[3]	焦文明, 高永霞, 胡德亮. 早期血液灌流在急性百草枯中毒患者中的应用效果观察[J]. 分子诊断与治疗杂志, 2020, 12(12):1732-1735.
[4]	董倩怡, 王秋. 血液灌流救治急性百草枯中毒的研究进展[J]. 医学综述, 2020, 26(15):3007-3011.
[5]	李江锋. 体外膜氧合联合连续性肾脏替代治疗在严重烧伤救治中的应用现状与挑战[J]. 中华烧伤与创面修复杂志, 2022, 38(5):433.
[6]	王超, 苏强, 张淑文, 等. 多器官功能障碍综合征诊断标准的多中心临床研究[J]. 中华外科杂志, 2009, 47(1):40-43.
[7]	Wang Y, Chen Y, Mao L, et al. Effects of hemoperfusion and continuous renal replacement therapy on patient survival following paraquat poisoning[J]. PLoS One, 2017, 12(7):e0181207.
[8]	Sharif AF, Fayed MM. Evaluation of multiple organ dysfunction score (MODS) and the Sequential Organ Failure Assessment (SOFA) score as in-hospital outcome predictors among cases of hydrogen cyanamide exposure: A cross-sectional study[J]. Environ Sci Pollut Res Int, 2021, 28(31):42161-42176. doi: 10.1007/s11356-021-13655-6
[9]	Pölkki A, Pekkarinen PT, Takala J, et al. Association of Sequential Organ Failure Assessment (SOFA) components with mortality[J]. Acta Anaesthesiol Scand, 2022, 66(6):731-741. doi: 10.1111/aas.14067 pmid: 35353902
[10]	黄坤, 闫敏, 杨一红, 等. 急性百草枯中毒患者并发MODS的危险因素及治疗探讨[J]. 临床急诊杂志, 2020, 21(11):900-904.
[11]	马涛, 邢宏运, 李晓明, 等. 急性百草枯中毒的预后因素分析[J]. 医药导报, 2020, 39(6):849-854.
[12]	罗丽英, 沈晔, 方玲翠. 不同综合治疗急性百草枯中毒的疗效观察及预后分析[J]. 浙江临床医学, 2022, 24(9):1329-1330.
[13]	Liu X, Yang H, Liu Z. Signaling pathways involved in paraquat-induced pulmonary toxicity: Molecular mechanisms and potential therapeutic drugs[J]. Int Immunopharmacol, 2022, 113(Pt A):109301.
[14]	Zuo Y, Xie J, Li X, et al. Ferritinophagy-mediated ferroptosis involved in paraquat-induced neurotoxicity of dopaminergic neurons: Implication for neurotoxicity in PD[J]. Oxid Med Cell Longev, 2021, 20(1):96-108.
[15]	Ding M, Zhang Y, Xu W, et al. MicroRNA-200b-3p as a biomarker for diagnosis and survival prognosis of multiple organ dysfunction syndrome caused by acute paraquat poisoning[J]. Hum Exp Toxicol, 2022 Jan-Dec; 41:96-112.
[16]	王伟, 孙磊, 章福彬, 等. 百草枯中毒浓度及中毒严重指数对急性百草枯中毒患者预后的影响[J]. 工业卫生与职业病, 2019, 45(4):282-285.
[17]	Nasr Isfahani S, Farajzadegan Z, Sabzghabaee AM, et al. Does hemoperfusion in combination with other treatments reduce the mortality of patients with paraquat poisoning more than hemoperfusion alone: A systematic review with meta-analysis[J]. J Res Med Sci, 2019, 2(4):61-68.
[18]	赵爽, 李新华, 范淑玲, 等. 血液灌流并连续性肾脏替代治疗和透析滤过治疗百草枯中毒疗效研究[J]. 中国实用内科杂志, 2017, 37(7):621-625.