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To evaluate the clinical efficacy and safety of fractionated plasma separation and adsorption integrated with continuous veno-venous hemofiltration (FPSA-CVVH) treatment in patients with acute bipyridine herbicide poisoning.
A retrospective analysis was conducted on 18 cases of acute bipyridine herbicide poisoning, of which 9 were poisoned by diquat and 9 by paraquat. All patients underwent FPSA-CVVH treatment.The whole blood was separated by a plasma component separator (EC40W), with the blood flow rate and the plasma separation rate setting at 180-250ml/min and 80-100 ml/min respectively; their plasma was filtered by a blood filter (AV600) with an ultrafiltration rate of 33 ml/min. Then the concentrated plasma passed through a neutral resin adsorption column (HA230) and an anion resin adsorption column (BRS350), before being transfused into the body. The process of FPSA-CVVH treatment lasted 8 hours, and a sequential therapy of CVVH lasted 16 hours,which was performed for 3 consecutive days. The combination of citric acid and low molecular weight heparin was applied in vitro, in order to prolong the activated coagulation time of whole blood by 1.5 - 2 times or to 200 seconds. The serum cytokine levels in pesticide-poisoned patients were assessed. The efficacy of FPSA-CVVH in eliminating cytokines, the 90-day survival rate of the poisoned patients, and any adverse reactions to treatment were observed.
14 patients (77.8%) had acute kidney injuries, and 10 (55.6%) had acute liver injuries. The serum cytokine levels of HMGB-1, IL-6, IL-8, IP-10, MCP-1, and MIP-1β were significantly elevated with median concentrations of 11225.5pg/ml, 550.13pg/ml, 284.51pg/ml, 43.01pg/ml, 811.94pg/ml, and 293.18pg/ml, respectively. A total of 41 FPSA-CVVH treatments were administered. After a single 8-hour FPSA-CVVH treatment, the decrease rates for HMGB-1, IL-6, IL-8, IP-10, MCP-1, and MIP-1β were 66.0%, 63.5%, 73.3%, 63.7%, 53.9%, and 54.1% respectively. During FPSA-CVVH treatment, one patient needed a filter change due to coagulation in the plasma component separator, and one showed a bleeding adverse reaction. The 90-day patient survival rate was 50%, with 4 cases of diquat poisoning and 5 of paraquat poisoning, and both liver and kidney functions were restored to normal. For survivors of paraquat poisoning, lung imaging showed only minimal inflammation in the early stages of the disease, and dynamic monitoring did not show progression.Baseline serum HMGB-1, IL-1 β, IL-6, and IL-8 were all significantly higher in deceased patients than in surviving patients.
Cytokine storm may play a significant role in the progression of multi-organ dysfunction in patients with acute bipyridine herbicide poisoning.FPSA-CVVH can effectively reduce cytokine levels, increase the success rate of treatment for acute bipyridine herbicide poisoning, and have a low incidence of adverse reactions.