血液灌流与盐酸戊乙奎醚联合治疗重度急性有机磷农药中毒的效果研究
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摘要
目的 :探讨血液灌流与盐酸戊乙奎醚联合治疗重度急性有机磷农药中毒(AOPP)的效果。方法 :选择2014年1月～2018年1月我院收治的重症AOPP患者120例,以随机数表法将其分为对照组与研究组,每组各60例。对照组患者入院后立即给予常规对症支持治疗,并应用碘解磷定与盐酸戊乙奎醚,研究组在对照组的基础上应用血液灌流治疗。评价两组患者不同时间(治疗前、治疗24h、48h时)血清胆碱酯酶(CHE)活性的变化、CHE恢复正常的时间;不同时间(治疗前与治疗24h时)血肌酐(Scr)、血清肌酸激酶同工酶(CK-MB)、天门冬氨酸氨基转移酶(AST)、血清肌钙蛋白I(cTnⅠ)水平的变化;治愈率与死亡率。结果 :治疗24h、48h时两组CHE活性均高于治疗前,其中研究组CHE活性高于对照组。研究组CHE恢复正常的时间低于对照组。治疗24h时两组Scr、CK-MB、AST、cTnⅠ水平均低于治疗前,其中研究组Scr、CK-MB、AST、cTnⅠ水平低于对照组。研究组治愈率93.33%,高于对照组78.33%;研究组死亡率3.33%,低于对照组13.33%。结论 :重度AOPP患者采用血液灌流联合盐酸戊乙奎醚治疗可以有效调控CHE水平,减轻心脏与肝肾功能损伤,降低死亡率,适于临床应用。
Objective To investigate the effect of hemoperfusion combined with penehyclidine hydrochloride in the treatment of severe acute organophosphorus pesticide poisoning(AOPP). Methods A total of 120 patients with severe AOPP admitted to our hospital from January 2014 to January in ～2018 were randomly divided into the control group and the study group, with 60 cases in each group. The two groups of patients were given routine symptomatic support treatment immediately after admission, and the study group was treated with hemoperfusion on the basis of the control group. The changes of serum cholinesterase(CHE) activity in two groups of patients(before treatment, treatment of 24 h, 48 h) and the time for CHE to restore normal; blood creatinine(Scr), serum creatine kinase isoenzyme(CK-MB), aspartate aminotransferase(AST) and serum calcium in different time(before and at 24 h) Changes in protein I(cTnⅠ) levels; cure rate and mortality. Results The activities of CHE in the two groups were higher than those before treatment in the treatment of 24 h and 48 h, and the CHE activity in the study group was higher than that in the control group. The recovery time of CHE in the study group was lower than that in the control group.The levels of Scr, CK-MB, AST and cTnⅠ in the two groups were lower than those before treatment, and the level of Scr, CKMB, AST and cTnⅠ in the study group was lower than that of the control group. The cure rate of the study group was 93.33%,higher than that of the control group 78.33%, and the mortality rate of the study group was 3.33%, which was lower than that of the control group 13.33%. Conclusion The treatment of severe AOPP patients with hemoperfusion combined with penehyclidine hydrochloride can effectively regulate the level of CHE, reduce the injury of heart and liver and kidney, reduce the mortality,and be suitable for clinical application.
Objective To investigate the effect of hemoperfusion combined with penehyclidine hydrochloride in the treatment of severe acute organophosphorus pesticide poisoning(AOPP). Methods A total of 120 patients with severe AOPP admitted to our hospital from January 2014 to January in ～2018 were randomly divided into the control group and the study group, with 60 cases in each group. The two groups of patients were given routine symptomatic support treatment immediately after admission, and the study group was treated with hemoperfusion on the basis of the control group. The changes of serum cholinesterase(CHE) activity in two groups of patients(before treatment, treatment of 24 h, 48 h) and the time for CHE to restore normal; blood creatinine(Scr), serum creatine kinase isoenzyme(CK-MB), aspartate aminotransferase(AST) and serum calcium in different time(before and at 24 h) Changes in protein I(cTnⅠ) levels; cure rate and mortality. Results The activities of CHE in the two groups were higher than those before treatment in the treatment of 24 h and 48 h, and the CHE activity in the study group was higher than that in the control group. The recovery time of CHE in the study group was lower than that in the control group.The levels of Scr, CK-MB, AST and cTnⅠ in the two groups were lower than those before treatment, and the level of Scr, CKMB, AST and cTnⅠ in the study group was lower than that of the control group. The cure rate of the study group was 93.33%,higher than that of the control group 78.33%, and the mortality rate of the study group was 3.33%, which was lower than that of the control group 13.33%. Conclusion The treatment of severe AOPP patients with hemoperfusion combined with penehyclidine hydrochloride can effectively regulate the level of CHE, reduce the injury of heart and liver and kidney, reduce the mortality,and be suitable for clinical application.
引文
[1]占钻,黄亮,曹春水.急诊重症监护室331例急性中毒患者临床特点分析[J].江西医药, 2018, 53(02):129-131.
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[10]韩学毅,李敏雄,区彩琼,等.血液灌流联合连续性静脉-静脉血液滤过治疗对急性有机磷农药中毒患者的心肌保护作用[J].南昌大学学报(医学版), 2017, 57(01):46-49.
[11]陈伟,周林,李清林,等.盐酸戊乙奎醚与阿托品治疗急性有机磷农药中毒过程中的谵妄对比研究[J].中国现代医学杂志, 2016,26(11):68-71.
[12]庞辉,赵曙光,孙廷强,等.血浆置换联合血液灌流在急性有机磷农药中毒救治中的应用[J].临床输血与检验, 2015, 17(06):484-486.
[13]张晨光,姚中侠,张英,等.血液灌流联合消化道清洗治疗重度有机磷农药中毒疗效观察[J].中国临床医生杂志, 2017, 45(05):52-54.
[14] ROMO GONZALES J E, SILVA OBREGON J, MARTIN DALGESSO C, et al. Evaluation of APACHEⅡ, SAPSⅡand sofa as predictors ofmortality in patients over 80 years admitted to ICU[J]. Intensive Care Med Exp, 2015, 3(Suppl 1):A343.
[15]李传明.重度急性有机磷农药中毒急救方案研究[J].中国药业,2015, 24(17):95-96.
[2]韩平.急性有机磷农药中毒死亡风险因素分析[J].中国医学工程,2017, 25(12):105-106.
[3]邓帅.有机磷农药中毒并发呼吸衰竭影响因素临床研究[J].湖南师范大学学报(医学版), 2017, 14(4):50-52.
[4]张晓敏,王晨.血液灌流对急性重度有机磷农药中毒患者SOFA评分与胆碱酯酶的影响[J].安徽医学, 2017, 38(09):1192-1194.
[5]赵池,邓晓琴,李永平.戊乙奎醚与阿托品治疗急性有机磷中毒的药物经济学分析[J].中国药房, 2017, 28(24):3347-3350.
[6]陈永忠,许志忠,朱再志,等.血液灌流对重度有机磷农药中毒疗效的临床观察[J].临床肾脏病杂志, 2017, 17(08):495-498.
[7]王永田,赵永芳,高三花,等.自拟大黄解毒汤联合血液灌流治疗急性有机磷农药中毒并发中毒性心肌炎患者的疗效观察[J].河北医药, 2017, 39(11):1676-1678.
[8]Chowdhary S, Bhattacharyya R, Banerjee D. Acute organ ophosphorus poisoning[J]. Clin Chim Acta, 2014, 20(431C):66-76.
[9]徐冰,莫莉,刘大鹏,等.采用血液灌流联合血液透析治疗86例急性肾衰竭的临床效果观察[J].湖南师范大学学报(医学版), 2015,12(1):48-51.
[10]韩学毅,李敏雄,区彩琼,等.血液灌流联合连续性静脉-静脉血液滤过治疗对急性有机磷农药中毒患者的心肌保护作用[J].南昌大学学报(医学版), 2017, 57(01):46-49.
[11]陈伟,周林,李清林,等.盐酸戊乙奎醚与阿托品治疗急性有机磷农药中毒过程中的谵妄对比研究[J].中国现代医学杂志, 2016,26(11):68-71.
[12]庞辉,赵曙光,孙廷强,等.血浆置换联合血液灌流在急性有机磷农药中毒救治中的应用[J].临床输血与检验, 2015, 17(06):484-486.
[13]张晨光,姚中侠,张英,等.血液灌流联合消化道清洗治疗重度有机磷农药中毒疗效观察[J].中国临床医生杂志, 2017, 45(05):52-54.
[14] ROMO GONZALES J E, SILVA OBREGON J, MARTIN DALGESSO C, et al. Evaluation of APACHEⅡ, SAPSⅡand sofa as predictors ofmortality in patients over 80 years admitted to ICU[J]. Intensive Care Med Exp, 2015, 3(Suppl 1):A343.
[15]李传明.重度急性有机磷农药中毒急救方案研究[J].中国药业,2015, 24(17):95-96.