Kết quả áp dụng phác đồ phối hợp liệu pháp ức chế miễn dịch với lọc máu hấp phụ than hoạt tính kết hợp thẩm tách máu ngắt quãng trong điều trị ngộ độc cấp Paraquat

Objective: To make initial comments on the clinical and para-clinical characteristics of the patients with acute paraquat intoxication and effective combination regimens of immunosuppressive therapy with charcoal hemoperfusion combined with intermittent hemodialysis in the paraquat poisoning treatment. Subject and method: A descriptive and prospective study on acute paraquat poisoning patients entered the Intesive care and Antitoxic Department - People's Hospital 115 from March 2009 to March 2011. Result: 12 patients (7 males,S females) enrolled into the study between March 2009 and March 2011; most of them were in the young age group (20-25 years of age accounted for 64 percent). The the most common clinical manifestations were mouth ulcers (10/12 patients - 83 percent), acute kidney injury (10/12 patients - 83 percent), respiratory failure (5/12 patients - 42 percent), and acute liver failure (4/12 patients 33 percent). Other common symptoms were tachycardia (100 percent), leukocytosis (100 percent), metabolic acidosis. Mouth ulcers, acute kidney injury, acute liver failure usually occurred within 3 days and usually recovered after 7 days if the patient did not die soon. Respiratory failure might occur early within 3 days (2/5 patients - 40 percent) or late after 7 days. There were 4 patients that died early within 7 days and the cause of death was respiratory and circulatory failure; 1 patient died later within 7-14 days and the cause of death was respiratory failure. The effect of hemoperfusion was increasing the excretion of paraquat (12/12 patients - 100 percent) and decreasing the mortality among paraquat blood levels 3 mg/L or urine paraquat concentrations 100 mg/L. Charcoal hemoperfusion is safe since it doesn't influence the vital organs (100 percent); it doesn't aggravate respiratory, cardiovascular, liver and kidney functions either. The most common complication was thrombocytopenia (83.3 percent) and there was only 1 patient with bleeding from the catheter site. The mild complications recovered spontaneously. Conclusion: The combined regimen of immunosuppressive therapy (methylprednisolone and cyclophophamide) and charcoal hemoperfusion combined with intermittent hemodialysis showed a lot of promises in the treatment of paraquat poisoning; however, further studies are needed.