临床误诊误治

目的 探究血浆吸附灌流治疗对急性抗凝血类鼠药中毒患者凝血功能预后的影响及相关因素。方法 回顾分析2015年5月至2021年1月确诊的105例急性抗凝血类鼠药中毒住院患者的临床资料，根据住院期间治疗方法的不同分为血浆灌流组和常规治疗组，常规治疗组在入院前后给予常规治疗，血浆灌流组在常规治疗基础上于入院后2 h内行血浆吸附灌流治疗。所有患者分别于入院当天及治疗后3、7 d行凝血功能检测，根据是否出现凝血功能异常及凝血功能恢复时间评估患者预后情况，并采用多因素logistic回归分析急性抗凝血类鼠药中毒患者凝血功能预后的影响因素。结果 2组治疗后3、7 d凝血酶原活动度（PTA）、国际标准化比值（INR）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）、凝血酶原时间（PT）比较均有明显差异，血浆灌流组PTA显著高于常规治疗组，INR、APTT、FIB、PT显著低于常规治疗组（P<0.01）。2组凝血功能预后比较差异有统计学意义（P<0.05）。中毒剂量和年龄是影响急性抗凝血类鼠药中毒患者凝血功能预后的危险因素，而血浆吸附灌流治疗是影响急性抗凝血类鼠药中毒患者凝血功能预后的保护因素（P<0.05,P<0.01）。结论 早期血浆吸附灌流治疗对急性抗凝血类鼠药中毒患者凝血功能预后有显著影响，中毒剂量、年龄、血浆吸附灌流治疗均能影响急性抗凝血类鼠药中毒患者凝血功能预后。早期血浆吸附灌流治疗可作为急性抗凝血类鼠药中毒的有效治疗方案。

Objective To explore the effect of plasma adsorption perfusion therapy on the prognosis of coagulation function in patients with acute anticoagulant rodenticide poisoning and prognosis-related factors. Methods The clinical data of 105 hospitalized patients with acute anticoagulant rodentcide poisoning diagnosed from May 2015 to January 2021 were retrospectively analyzed. According to the different treatment methods during hospitalization, the patients were divided into plasma perfusion group and conventional treatment group. The conventional treatment group was given conventional treatment, and the plasma perfusion group was given plasma adsorption perfusion within 2 h after admission on the basis of conventional treatment.The coagulation function of all patients was detected within 1 h after admission and at 3 and 7 d after treatment. The prognosis of patients was evaluated according to whether there was abnormal coagulation function and the recovery time of coagulation function.Multivariate logistic regression was used to analyze the influencing factors of the prognosis of coagulation function in patients with acute anticoagulant rodenticide poisoning. Results There were significant differences in prothrombin activity(PTA), international normalized ratio(INR), activated partial thromboplastin time(APTT), fibrinogen(FIB) and prothrombin time(PT) at 3 and 7 d after treatment. The PTA in the plasma perfusion group was significantly higher than that in the conventional treatment group. INR,APTT, FIB and PT in the treatment group were significantly lower than those in the conventional treatment group(P<0.01). There were significant differences in the prognosis of coagulation function between the two groups(P<0.05). Poisoning dose and age were the risk factors, while plasma adsorption perfusion therapy was the protective factor affecting the prognosis of coagulation function in patients with acute anticoagulant rodenticide poisoning(P<0.05, P<0.01). Conclusion Early plasma adsorption perfusion therapy has a significant effect on the prognosis of coagulation function in patients with acute anticoagulant rodenticide poisoning.Poisoning dose, age and plasma adsorption perfusion therapy can affect the prognosis of coagulation function in patients with acute anticoagulant rodenticide poisoning. Early plasma adsorption perfusion therapy can be used as an effective treatment plan.