目的了解江苏省内血液净化在急性中毒救治中的使用现状。
方法这是一项多中心、横断面、真实世界的观察性研究。研究对象为2015年6月至2019年5月在江苏省的9家医院急诊科就诊的中毒患者进行观察随访，记录了患者人口统计学特征，急诊就诊后第1个小时的生命体征、治疗措施以及患者住院时间和生存情况。采用Wilcoxon秩和检验和卡方检验对接受体外血液净化治疗和未接受体外血液净化治疗的两组患者的临床数据进行了比较。
结果共纳入4 178例中毒患者。其中21.7%（908/4 178）的中毒患者接受了血液净化，78.3%（3 270/4 178）的患者未接受血液净化。血液灌流（90.4%）最常见，其次是连续肾脏替代疗法（4.4%）。在两种或两种以上的混合血液纯化模式中，4.8%接受血灌注联合连续肾脏替代疗法，0.1%接受血灌注联合血浆置换，0.1%接受血灌注联合连续肾脏替代疗法和血浆置换。在接受血液净化治疗的患者中，农药中毒（76.3%）最多见，最常见农药依次为百草枯（23.7%）、敌敌畏（8.7%）、甲胺磷（5.2%）、乐果（4.0%）和草甘膦（3.7%）。与非血液净化组相比，血液净化组入院第1小时内低GCS评分（3~8）患者更多（22.6% vs. 9.7%， P <0.05），低平均动脉压患者更多（8.0% vs. 3.2%， P <0.05），住院时间更长[5(3, 9) d vs. 2(1, 4) d， P <0.05]，病死率更高（21.1% vs. 5.3%， P <0.05）。出院后28 d通过电话随访，血液净化组的存活率为78.9%，病死率为21.1%。
结论血液灌流是江苏省治疗中毒最常用的血液净化方法，农药是最常见的应用血液灌流治疗的毒物。
ObjectiveTo investigate the current application of blood purification in the treatment of acute poisoning within Jiangsu Province and to evaluate the impact of extracorporeal blood purification on the clinical outcomes of critically poisoned patients.
MethodsThis multicenter, cross-sectional real-world observational study followed patients presenting with poisoning to the emergency departments of nine hospitals in Jiangsu Province between June 2015 and May 2019. Data were collected on demographic characteristics, vital signs within the first hour of emergency presentation, treatment modalities, length of hospital stay, and survival outcomes. Clinical data from patients who underwent extracorporeal blood purification were compared with those who did not, using the Wilcoxon rank-sum test and Chi-square test.
ResultsA total of 4 178 poisoning cases were included between June 2015 and May 2019. Among them, 21.7% (908/4 178) received blood purification therapy, while 78.3% (3 270/4 178) did not. Hemoperfusion (90.4%) was the most frequently employed method, followed by continuous renal replacement therapy (CRRT) (4.4%). In combined blood purification modalities, 4.8% underwent hemoperfusion combined with CRRT, 0.1% received hemoperfusion with plasma exchange, and another 0.1% underwent hemoperfusion combined with both CRRT and plasma exchange. Among patients who underwent blood purification, pesticide poisoning was the most prevalent (76.3%), with the most common toxic agents being paraquat (23.7%), dichlorvos (8.7%), methamidophos (5.2%), omethoate (4.0%), and glyphosate (3.7%). Compared to the non-blood purification group, patients in the blood purification group were more likely to present within the first hour with a low Glasgow Coma Scale (GCS) score (3-8) (22.6% vs. 9.7%, P <0.05), low mean arterial pressure (8.0% vs. 3.2%, P <0.05), longer hospital stays [5(3,9) days vs. 2(1,4) days, P <0.05] and a higher in-hospital mortality rate (21.1% vs. 5.3%, P <0.05). Follow-up via telephone 28 days after discharge revealed a survival rate of 78.9%, with a mortality rate of 21.1% in the blood purification group.
ConclusionsHemoperfusion is the most commonly utilized blood purification technique for treating poisoning in Jiangsu Province, with pesticides being the primary toxic agents treated. Although the mortality rate is higher in the blood purification group, the intervention may still contribute to improved patient outcomes.
乔莉,张劲松,陈建荣,等. 江苏省908例体外血液净化治疗急性中毒：一项横断面、多中心的真实世界研究[J]. 中华急诊医学杂志,2025,34(03)：369-375.
DOI:10.3760/cma.j.issn.1671-0282.2025.03.013版权归中华医学会所有。
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乔莉：研究的实施，撰写文稿；乔莉、陈建荣、沈君华、刘励军、赵旭明、耿平、孙虹、孙青松、杜叶平、杨海晨、田志光、马建军、杨如山：收集临床数据，并对数据进行质控；秦正、吴姗姗、潘裕民：数据整理和随访；吴义刚：数据整理、协助论文撰写；张劲松：研究设计，申请研究经费
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