길효욱

Extracorporeal therapy for intoxication

길 효 욱

2008 년 Adsorba 국내 사용 수량

273

273

478

478

415415143

143

2007년

2008년

2009년 (8월 )

1114 1309 1023

• 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%)

APACHE II scores

생 사5.97 ± 5.57 8.94 ± 6.07

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.

결론

• Extrcorporeal therapy – Useful method.

• Nephrologist - Extracorporeal therapy

• 적절한 방법을 선택하여 치료 중독환자의 생존률을 향상 .