길효욱 Extracorporeal therapy for intoxication 길 효 욱길 효 욱

2008 년 Adsorba 국내 사용 수량 년 2008 년 2009 년 (8 월 )

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 ml/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 ± [13, 93] Sex (n) Males451 (56.2%) Females352 (43.8%) Underlying disease Diabetes mellitus Hypertension Liver cirrhosis Malignancy APAHCE II score7.48 ± 6.08

WBC ± Hemoglobin ± 1.97 Platelet ± Albumin 4.48 ± 0.54 Total bilirubin (mg/dl) 0.85 ± 1.02 AST (IU/L) ± [10, 912] ALT (IU/L) ± [3, 856] Blood urea nitrogen (mg/dl) ± 9.43 Creatinine (mg/dl) 1.10 ± 0.93 Calcium 8.81 ± 0.80 Phosphate 3.49 ± 1.53 Uric acid (mg/dl) 5.58 ± 2.17 Amylase (IU/L) ± Lipase (IU/L) ± PT (INR) 1.03 ± 0.15 aPTT(sec) ± 9.27 pH 7.37 ± 0.10 PaCO 2 (mmHg) ± 9.44 PaO 2 (mmHg) ± HCO 3 - (mEq/L) ± 5.19

Non-pesticide (42) Aspirin3 Morphine2 Bromadilone3 Methimazole3 Phenytoin2 Calcium channel blocker1 Doxylamine10 NSAID2 Multiple drugs of anti-depressant agent (diazepam, SSRI, TCA)16 Pesticide (749) HerbcideParaquat492 Glyphosate or Glufosinate65 The others or unknown herbicide45 InsecticideOrganophosate insecticide67 Carbamate16 Pyrethroid25 Organochloride2 Mixed drug composition of organophosphate and pyrethroid18 The others or unknown insecticide6 The others or unknowns17 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%)

Hypotension16 Hypoxia9 Cardiac arrest5 Clotting of absorba1 Catheter related hematoma1 Upper gastrointestinal bleeding1 Vomiting1 The cessation of hemoperfusion : 34 cases (4.2%) Gross Hematuria9 Upper gastrointestinal bleeding6 Oral cavity bleeding6 Hemoptysis2 Epistasix2 Ear bleeding1 The systemic bleeding after hemoperfusion : 26 cases (3.2%)

Bleeding :26 cases 생 5, 사 16, 전원 5 Paraquat 12, Glyphosate 4, Organophosphate 5, Organo+pyreth :1 glyphosate+organo : 1 other insecticide : 1 methimazole : 1, multiple depressant drug: 1

Pre-HemoperfusionPost-Hemoperfusion Platelet (592) ± ± Calcium (194)8.96 ± ± 0.98 Phosphate (134)3.72 ± ± 1.17 Hypocalcemia : 134/194cases Thrombocytopenia : 184/592cases

생존 385 (47.9%) 사망 356 (44.4%) 전원 62 (7.7%) 제초제살충제제초제 + 살충제 기타 Total 생 233 (41.2%) 92 (85.2%) 2 (50%) 사 332 (58.8%) 16 (14.8%) 2 (50%) 0350

ParaquatGlyphosate 그외 제초제 생 157 (32.9%) 45 (83.3%) 33 (86.8%) 사 320 (67.1%) 9 (16.9%) 5 (13.2%) Organop hosphate Carbamat e PyrethroidOrganochlorineOrganopho sphate+pyr ethroid 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 생사 5.97 ± ± 6.07

생존 157 사망 320 전원 15 Paraquat Glyphosate or glufosinate 생존 44 사망 8 전원 11 The others or unknown herbicide 생존 32 사망 4 전원 7 생존 43 사망 10 전원 12 Organophosphate 생존 11 사망 1 전원 4 Carbamate Pyrethroid 생존 18 사망 2 전원 3

생존 2 Organochlorine 생존 13 사망 2 전원 3 Mixed drug composition of organophosphate and pyrethroid The others or unknown insecticide 생존 5 사망 1

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.