길효욱 Extracorporeal therapy for intoxication 길 효 욱길 효 욱.
-
Upload
randolf-price -
Category
Documents
-
view
217 -
download
3
Transcript of 길효욱 Extracorporeal therapy for intoxication 길 효 욱길 효 욱.
• 기간 : 2006 년 1 월 – 2008 년 12 월• Hemoperfusion (Celluose membrane, absroba 200,
Gambro, Gambro Dialysatoren Gmb H Co. KG Hechingen Germany )
• Blood flow 200-250ml/min • One time : 3hr 30min• Anticoagulation Bolus 2000 U Maintenance 3000 U
General characteristics and initial parameters of the 803 patients with Hemoperfusion
Age (years) 50.13 ± 15.99 [13 , 93]Sex (n)Males 451 (56.2%)Females 352 (43.8%)
Underlying diseaseDiabetes mellitusHypertensionLiver cirrhosisMalignancy
8711987
APAHCE II score 7.48 ± 6.08
WBC 14933.88 ± 7201.03Hemoglobin 14.19 ± 1.97Platelet 243.71 ± 67.03Albumin 4.48 ± 0.54Total bilirubin (mg/dl) 0.85 ± 1.02AST (IU/L) 50.51 ± 83.15 [10, 912]ALT (IU/L) 34.80 ± 60.09 [3, 856]Blood urea nitrogen (mg/dl) 14.71 ± 9.43Creatinine (mg/dl) 1.10 ± 0.93Calcium 8.81 ± 0.80Phosphate 3.49 ± 1.53Uric acid (mg/dl) 5.58 ± 2.17Amylase (IU/L) 292.67 ± 349.12Lipase (IU/L) 89.20 ± 228.70PT (INR) 1.03 ± 0.15aPTT(sec) 25.82 ± 9.27pH 7.37 ± 0.10PaCO2 (mmHg) 32.30 ± 9.44PaO2 (mmHg) 94.02 ± 24.33HCO3
- (mEq/L) 18.65 ± 5.19
Non-pesticide (42)
Aspirin 3
Morphine 2
Bromadilone 3
Methimazole 3
Phenytoin 2
Calcium channel blocker 1
Doxylamine 10
NSAID 2
Multiple drugs of anti-depressant agent (diazepam, SSRI, TCA) 16
Pesticide (749)
Herbcide Paraquat 492
Glyphosate or Glufosinate 65
The others or unknown herbicide 45
Insecticide Organophosate insecticide 67
Carbamate 16
Pyrethroid 25
Organochloride 2
Mixed drug composition of organophosphate and pyrethroid 18
The others or unknown insecticide 6
The others or unknowns 17
•Four cases was simultaneously herbicide and insecticide poisoning.
The frequency of hemoperfusion Single : 718 cases Sequential : 85 cases
Catheter Jugular catheter : 678 (84.4%) Subclavian catheter : 30 (3.7%) Femoral catheter : 95 (11.8%)
Pneumothorax : 2cases
Catheter related bleeding : 57cases (7.1%) Hemoperfusion without heparin : 25cases
The frequency of hemoperfusion Single : 718 cases Sequential : 85 cases
Catheter Jugular catheter : 678 (84.4%) Subclavian catheter : 30 (3.7%) Femoral catheter : 95 (11.8%)
Pneumothorax : 2cases
Catheter related bleeding : 57cases (7.1%) Hemoperfusion without heparin : 25cases
Hypotension during hemoperfusion (systolic pressure < 90mmHg) : 174 cases (21.7%)
Hypotension requiring inotropic agents : 7cases
The time of occurring of hypotension during hypotension Within 30 min : 12cases Between 30 min and 60min : 80 cases Between 60 min and 120min : 69 cases Above 120 min : 13 cases Clotting of absorba : 12 cases (1.5%)
Hypotension 16
Hypoxia 9
Cardiac arrest 5
Clotting of absorba 1
Catheter related hematoma 1
Upper gastrointestinal bleeding 1
Vomiting 1
The cessation of hemoperfusion : 34 cases (4.2%)
Gross Hematuria 9
Upper gastrointestinal bleeding 6
Oral cavity bleeding 6
Hemoptysis 2
Epistasix 2
Ear bleeding 1
The systemic bleeding after hemoperfusion : 26 cases (3.2%)
Pre-
Hemoperfusion
Post-
Hemoperfusion
Platelet (592) 241.26 ± 66.08 132.56 ± 56.61
Calcium (194) 8.96 ± 0.82 7.40 ± 0.98
Phosphate (134) 3.72 ± 1.66 2.65 ± 1.17
Hypocalcemia : 134/194cases
Thrombocytopenia : 184/592cases
생존 385 (47.9%)
사망 356 (44.4%)
전원 62 (7.7%)
제초제 살충제 제초제 + 살충제
기타 Total
생 233 (41.2%)
92(85.2%)
2(50%)
13 340
사 332(58.8%)
16(14.8%)
2(50%)
0 350
Paraquat Glyphosate
그외 제초제
생 157(32.9%)
45(83.3%)
33(86.8%)
사 320(67.1%)
9(16.9%)
5(13.2%)
Organophosphate
Carbamate
Pyrethroid
Organochlorine
Organophosphate+pyrethroid
others
생 44(80%)
11(91.7%)
19(86.4%)
2(100%)
13(86.7%)
5(83.3%)
사 11(20%)
1(8.3%)
3(13.6%)
0(0%)
2(13.3%)
1(16.7%)
Smmary
Catheter related bleeding : 57cases (7.1%)Clotting of absorba : 12 cases (1.5%)The systemic bleeding after hemoperfusion :
26 cases (3.2%)Platelet and calcium decreased. The mortality of each drugs is different.