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Objective:To evaluate the therapeutic effect of hemopurification on acute chlorfenapyr poisoning according to the blood concentration of chlorfenapyr and to provide experience for clinical treatment.Methods:Two patients who presented to our Emergency Department following an ingestion of chlorfenapyr and then were treated with hemopurification in 2022 were included. The concentrations of chlorfenapyr and its highly toxic metabolite tralopyril were dynamically monitored, and the clinical data of the patients were collected.Results:Case 1 was given hemoperfusion for the first time 13 hours after ingestion. During l hour hemoperfusion, the tralopyril decreased by 28.82%. The concentration increased and exceeded the pre-perfusion level after 2 hours of hemoperfusion. After three times of hemoperfusion, the concentrations of chlorfenapyr and tralopyril were still higher than those before the first time, reaching 248 ng/mL and 1 307 ng/mL respectively. The concentration of chlorfenapyr showed a downward trend after 130 h, and the tralopyril in blood reached the peak 3 164 ng/mL at 130 h and decreased to 2 707 ng/mL at 178 h. In case 2, the blood chlorfenapyr and tralopyril concentration was 392 ng/mL and 7 598 ng/mL respectively 150 hours after ingestion. The blood chlorfenapyr concentration decreased by 37.75% respectively after first hemoperfusion, and the tralopyril concentration decreased by 38.02% respectively. During 85 hours of continuous veno-venous hemodiafiltration (CVVHDF), the concentration of tralopyril was maintained at 4 234~6 410 ng/mL. Case 1 was followed up to 12 days and lost follow-up. Case 2 died and the survival time was 247 hours.Conclusions:Hemoperfusion can scavenge tralopyril, but CVVHDF has poor scavenging ability for tralopyril. And the apparent volume of distribution (Vd) of chlorfenapyr and tralopyril are large. After ingestion, chlorfenapyr spreads to various tissues quickly, and it is easy to accumulate in the adipose tissue. The chlorfenapyr in the tissue slowly is released back to the blood and stays in the blood for a long time. The peak concentration of chlorfenapyr appeared earlier than that of tralopyril. Clinicians should pay attention to the early removal of toxins from the digestive tract.
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Objective To investigate the effects of hemodialysis combined with hemopurification and comprehensive nursing intervention on the levels of interleukin -6 (IL-6), C-reactive protein (CRP) and β2- microglobulin (β2- MG) in patients with diabetic nephropathy (DN). Methods A total of 68 patients with DN were selected in our hospital, and were treated with hemodialysis combined with hemopurification. The control group was treated with routine nursing intervention, and the observation group was given comprehensive nursing intervention, with 34 cases in each group. The differences in the levels of IL- 6, CRP and β2- MG before and after treatment were compared between the two groups. Results In the control group, the level of IL-6 before treatment [(121.85±34.95) pg/ml] and 1 month after treatment [(120.53 ± 24.95) pg/ml] and 3 months [(119.05 ± 25.73) pg/ml] showed no significant difference (P>0.05). The level of IL-6 in the observation group for 1 month after treatment [(98.90±20.52) pg/ml] and 3 months [(70.32 ± 10.43) pg/ml] was significantly lower than that before treatment, and significantly lower than those in the control group (P<0.05). There was no significant difference in the level of CRPbetween the control group before treatment [(12.64 ± 3.08) mg/L] and 1 month after treatment (12.64±3.15) mg/L] and 3 months [12.89±4.02] mg/L] (P>0.05); the level of CRP at 1 month after treatment [(9.24 ± 3.24)mg/L] and 3 months after treatment [(7.04 ± 2.54)mg/L] in the observation group was significantly lower than that before the treatment, and significantly lower than those in the control group (P<0.05).The level of β2-MG in the control group at 1 month [(10.24±1.79) mg/L] and 3 months after treatment [(9.01 ± 1.47) mg/L] were significantly lower than before the treatment (12.53 ± 3.45) mg/L];thelevel of β2-MG at 1 month [(9.03±1.68) mg/L] and 3 months after treatment [(6.73±1.73)mg/L] in the observation group was also significantly lower thanthat before the treatment, and significantly lower than those in the control group (P<0.05). Conclusions Hemodialysis combined with hemopurification and comprehensive nursing intervention can effectively inhibit the release of inflammatory factors and reduce the inflammatory state, so it has good clinical application value.
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Objective To comprehensively evaluate the clinical efficacy of hemoperfusion (HP) combined with continuous veno-venous hemofiltration (CVVH) on acute paraquat poisoning (APP).Methods Literatures of Chinese and English randomized controlled trials (RCTs), case control and cohort study on HP combined with CVVH in the treatment of APP from the PubMed, Embase, Wanfang, and CNKI up to November 2017 were enrolled (the subjects were > 16 years old). The obtained literatures were strictly screened and evaluated in quality, and data such as mortality, the life time of dead patients, inefficiency rate, incidence of multiple organ dysfunction syndrome (MODS) and acute respiratory distress syndrome (ARDS) were extracted. Meta-analysis was performed by RevMan 5.3. Results Twenty-one studies were included with 2222 subjects, among whom 976 subjects were in HP combined with CVVH group (experimental group) and 1246 subjects in HP group (control group). Compared with control group, the mortality in experimental group were significantly decreased [43.77％ (362/827) vs. 55.26％ (604/1093), odds ratio (OR) =0.68, 95％ confidential interval (95％CI) = 0.56-0.82,P = 0.0001], the life time of death patients was significantly prolonged [mean difference (MD) = 4.63, 95％CI = 2.60-6.66,P < 0.00001], incidence of MODS [25.93％ (70/270) vs. 55.36％ (155/280),OR = 0.26, 95％CI = 0.14-0.49,P< 0.0001], and incidence of ARDS [30.37％ (82/270) vs. 51.07％(143/280),OR = 0.42, 95％CI = 0.30-0.61,P < 0.00001], and inefficiency rate [8.72％ (13/149) vs. 34.64％ (53/153),OR=0.17, 95％CI = 0.09-0.34, P < 0.00001] were significantly reduced. Funnel chart showed that except the publication bias of mortality rate, there were less publication bias about other indicators among studies.Conclusion HP combined with CVVH can significantly reduce the mortality of patients with APP compared with HP alone on the whole, prolong the life time and reduce the occurrence of MODS and ARDS, thus improving the treatment efficiency.
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Objective To study the effect of different dialysis modalities on pruritus in uremic patients .Methods Patients with maintenance hemodialysis who were suffered with severe cutaneous pruritus were randomly divided into hemodialysis group (HD group) ,hemodialysis combined with hemodiafiltration group (HD+ HDF group) ,hemodialysis and hemodiafiltration combined with hemoperfusion group (HD+ HDF+ HP group) .Plasma P3+ ,parathyroid hormone (PTH) and β2-microglobulin (β2-MG) were measured at pre-dialysis ,1 weeks ,4 weeks and 12 weeks after dialysis ,cutaneous pruritus was scored too .Results Compared with pre-dialysis ,the level of plasma P3+ ,PTH ,β2-MG and the scores of cutaneous pruritus were significantly lower at 4 weeks and 12 weeks after dialysis in HD+ HDF+ HP group (P<0 .05) .The were statistically significant difference in P3+ ,PTH ,β2-MG and cu-taneous pruritus scores among 3 groups after 12 weeks (P<0 .05) .Conclusion HD+ HDF+ HP is superior to HD+ HDF in effi-ciently clear P3+ ,PT H andβ2-M G ,and relief cutaneous pruritus and itching .