血液灌注对急性百草枯中毒的治疗效果及机制研究进展

Progress of Research on the Therapeutic Effect and Mechanism of Hemoperfusion on Acute Paraquat Poisoning

摘要: 目的：系统分析血液灌流(HP)治疗百草枯(PQ)中毒的现存争议，并明确未来研究方向。方法：基于PubMed、CNKI等数据库的27篇文献(2010~2023年)，筛选临床研究、Meta分析及基础实验证据，聚焦HP的疗效争议、技术瓶颈及转化医学挑战。结果：HP对高毒物负荷患者生存率无显著改善，“黄金4小时”时间窗与毒物负荷的预后价值存在分歧。树脂与活性炭的吸附效率差异缺乏头对头RCT支持；基层医院HP设备覆盖率低，且操作并发症风险高。未来需开展多中心RCT验证联合治疗(HP + CVVH)的生存获益；进行靶向吸附材料研究；便携式设备与远程指导系统可缩短基层HP启动时间。结论：血液灌流是百草枯中毒早期救治的核心手段，但其疗效受剂量、时间窗及技术参数限制。未来应通过技术创新与资源整合推动精准化、公平化中毒救治体系建设。个体化治疗策略与多学科协作是突破当前瓶颈的关键方向。

Abstract: Objective: To systematically analyze the existing controversies surrounding hemoperfusion (HP) in the treatment of paraquat (PQ) poisoning and clarify future research priorities. Methods: A comprehensive review of 27 studies (2010~2023) from PubMed, CNKI, and other databases was conducted, including clinical research, meta-analyses, and experimental evidence. The analysis focused on debates regarding HP efficacy, technical challenges, and translational medicine barriers. Results: Hemoperfusion (HP) does not significantly improve the survival rate of patients with high toxin load. There is still controversy regarding the prognostic value of the “golden 4-hour” time window in relation to toxin load. The difference in adsorption efficiency between resin and activated carbon lacks head-to-head randomized controlled trial (RCT) support. Additionally, the coverage rate of HP equipment in primary hospitals is low, and the risk of procedural complications is high. Future directions should include conducting multicenter RCTs to verify the survival benefits of combined therapy (HP + CVVH), researching targeted adsorption materials, and developing portable devices and remote guidance systems to shorten the time to initiate HP in primary hospitals. Conclusion: Hemoperfusion remains a cornerstone intervention for early-stage PQ poisoning management, yet its efficacy is constrained by dosage, time window, and technical parameters. Future strategies should integrate technological innovation and resource optimization to establish a precision-based and equitable poisoning treatment system. Individualized therapeutic protocols and multidisciplinary collaboration are pivotal for overcoming current limitations.