长托宁、血必净联合血液灌流对急性重度有机磷中毒患者血清炎性因子及心肌酶的影响
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摘要
目的:探讨长托宁、血必净联合血液灌流对急性重度有机磷农药中毒(AOPP)患者血清炎性因子及心肌酶的影响。方法:选取我院收治的92例急性重度AOPP患者。按随机分组法将所有患者分为观察组和对照组(n=46)。对照组采用长托宁、血必净,观察组采用长托宁、血必净联合血液灌流治疗。比较两组临床指标、血清炎性因子、心肌酶指标、并发症发生情况及不良反应发生情况。结果:观察组阿托品使用剂量、恢复清醒时间、ChE恢复时间、住院时间均显著低于对照组,治愈率显著高于对照组(P<0.05),两组死亡率无统计学意义(P>0.05)。观察组TNF-α、IL-8、IL-18显著低于对照组(P<0.05)。观察组CK、CK-MB、LDH、AST显著低于对照组(P<0.05)。观察组并发症发生率(中间综合征、呼吸衰竭、肺部感染、肺水肿)显著低于对照组(P<0.05)。观察组不良反应发生率(肌痛、乏力、消化道反应、肝功能异常)显著低于对照组(P<0.05)。结论:长托宁、血必净联合血液灌流对急性重度有机磷中毒患者效果显著,可有效降低炎性因子,改善心肌酶指标。
Objective: To investigate the effects of penehyclidine hydrochloride, xuebijing combined with hemoperfusion on serum inflammatory factors and myocardial enzymes in patients with acute severe organophosphorus poisoning(AOPP). Methods:From July 2015 to June 2018, 92 patients with acute severe AOPP were selected. All patients were randomly divided into observation group and control group(n=46). The control group was treated with penehyclidine hydrochloride and xuebijing, while the observation group was treated with penehyclidine hydrochloride, xuebijing combined with hemoperfusion. The clinical indexes, serum inflammatory factors, myocardial enzymes, complications and adverse reactions were compared between the two groups. Results:Compare with the control group, the dosage of atropine, recovery time, ChE recovery time, hospital stay in the observation group were significantly lower, and the cure rate was significantly higher(P<0.05), mortality had no significant difference(P>0.05). Compare with the control group, TNF-α, IL-8 and IL-18 in the observation group were significantly lower(P<0.05). Compare with the control group, CK, CK-MB, LDH, AST in the observation group was significantly lower(P<0.05). Compare with the control group, the incidence of complications(intermediate syndrome, respiratory failure, pulmonary infection, pulmonary edema) in the observation group was significantly lower(P<0.05). Compare with the control group, the incidence of adverse reactions(myalgia, fatigue, digestive tract reaction, abnormal liver function) in the observation group was significantly lower(P<0.05). Conclusion: Penehyclidine hydrochloride, xuebijing combined with hemoperfusion have a significant effect on acute severe organophosphorus poisoning patients, can effectively reduce inflammatory factors and improve myocardial enzyme index.
Objective: To investigate the effects of penehyclidine hydrochloride, xuebijing combined with hemoperfusion on serum inflammatory factors and myocardial enzymes in patients with acute severe organophosphorus poisoning(AOPP). Methods:From July 2015 to June 2018, 92 patients with acute severe AOPP were selected. All patients were randomly divided into observation group and control group(n=46). The control group was treated with penehyclidine hydrochloride and xuebijing, while the observation group was treated with penehyclidine hydrochloride, xuebijing combined with hemoperfusion. The clinical indexes, serum inflammatory factors, myocardial enzymes, complications and adverse reactions were compared between the two groups. Results:Compare with the control group, the dosage of atropine, recovery time, ChE recovery time, hospital stay in the observation group were significantly lower, and the cure rate was significantly higher(P<0.05), mortality had no significant difference(P>0.05). Compare with the control group, TNF-α, IL-8 and IL-18 in the observation group were significantly lower(P<0.05). Compare with the control group, CK, CK-MB, LDH, AST in the observation group was significantly lower(P<0.05). Compare with the control group, the incidence of complications(intermediate syndrome, respiratory failure, pulmonary infection, pulmonary edema) in the observation group was significantly lower(P<0.05). Compare with the control group, the incidence of adverse reactions(myalgia, fatigue, digestive tract reaction, abnormal liver function) in the observation group was significantly lower(P<0.05). Conclusion: Penehyclidine hydrochloride, xuebijing combined with hemoperfusion have a significant effect on acute severe organophosphorus poisoning patients, can effectively reduce inflammatory factors and improve myocardial enzyme index.
引文
1刘胜利.重度有机磷农药中毒的抢救治疗分析[J].中国医药导刊,2016,18(7):677-678.
2涂学平,袁鹰,向鑫,等.阿托品与长托宁联合治疗重度急性有机磷农药中毒的疗效[J].临床急诊杂志,2016,34(12):932-934.
3张秋峰.血必净注射液联合氯解磷定注射液治疗有机磷农药中毒的临床研究[J].现代药物与临床,2017,32(6):1057-1060.
4覃立行,潘靖华,苏家林,等.急性重度有机磷农药中毒行血浆置换联合血液灌流治疗的临床效果以及对炎性因子的影响[J].临床急诊杂志,2016,26(4):286-288.
5朱子扬,龚兆庆,汪国良.中毒急救手册[M].3版.上海:上海科学技术出版社,2007:937-952.
6高茹春,赵建娅,潘爱群,等.急性有机磷农药中毒患者血清及全血胆碱酯酶的相关性研究[J].重庆医学,2016,45(5):648-650.
7廖汉文,朱梦,孟东勇.血液灌流联合血液滤过对治疗急性重度有机磷农药中毒的临床研究[J].中国中西医结合肾病杂志,2016,17(2):137-138.
8钱丽娜.急性重度有机磷农药中毒长托宁联合血液灌流疗法的应用分析[J].湖南中医药大学学报,2016,24(A02):1333.
9王飞.长托宁对急性有机磷农药中毒患者血气分析、心肌酶谱及炎症因子的影响[J].中国急救复苏与灾害医学杂志,2017,12(10):1007-1010.
10陆伟荣,吴先正.血必净对有机磷中毒血液灌流患者的治疗效果及作用机制[J].山东医药,2017,57(24):94-96.
11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(8):495-498.
12蔡雪,刘鑫,韩雪,等.血液灌流联合长托宁对急性有机磷中毒患者血清高敏C反应蛋白和白细胞介素-18的影响[J].疑难病杂志,2017,16(6):596-599.
13侯景玉,吴畏,陈希妍,等.序贯性血液净化治疗急性重度有机磷农药中毒并发多器官功能障碍综合征疗效观察[J].新乡医学院学报,2016,33(2):126-129.
14王永田,赵永芳,高三花,等.急性有机磷农药中毒患者血清心肌酶谱变化[J].河北医药,2016,38(17):2592-2594.
15 Liu L,Ding G.Effects of different blood purification methods on serum cytokine levels and prognosis in patients with acute severe organophosphorus pesticide poisoning[J].Ther Apher Dial,2015,19(2):185-190.
16田应海,陈秋霞,邓小莹,等.血必净注射液对重度急性有机磷农药中毒患者血清CRP、TNF-α及IL-6水平的影响[J].中成药,2017,39(7):1365-1368.
17 Yesilbas O,Kihtir HS,Altiti M,et al.Acute severe organophosphate poisoning in a child who was successfully treated with therapeutic plasma exchange,highvolume hemodiafiltration,and lipid infusion[J].J Clin Apher,2016,31(5):467-469.
18 Kovalevsky A,Blumenthal DK,Cheng X,et al.Limitations in current acetylcholinesterase structure:based design of oxime antidotes for organophosphate poisoning[J].Ann N Y Acad Sci,2016,1378(1):41-49.
19 Reji KK,Mathew V,Zachariah A,et al.Extrapyramidal effects of acute organophosphate poisoning[J].Clin Toxicol(Phila),2016,54(3):259-265.
20 Lin JN,Lin CL,Lin MC,et al.Increased risk of dementia in patients with acute organophosphate and carbamate poisoning:a nationwide Population-Based cohort study[J].Medicine(Baltimore),2015,94(29):el187.
21 Lee FY,Chen WK,Lin CL,et a1.Organophosphate poisoning and subsequent acute kidney injury risk:a nationwide Population-Based cohort study[J].Medicine(Baltimore),2015,94(47):2107.
22 Duta P,Kamath SS,Bhlala A,et al.Effects of acute organophosphate poisoning on pituitary target gland hormones at admission,discharge and three months after poisoning:A hospital based pilot study[J].Indian JEndoerinol Metab,2015,19(1):116-123.
2涂学平,袁鹰,向鑫,等.阿托品与长托宁联合治疗重度急性有机磷农药中毒的疗效[J].临床急诊杂志,2016,34(12):932-934.
3张秋峰.血必净注射液联合氯解磷定注射液治疗有机磷农药中毒的临床研究[J].现代药物与临床,2017,32(6):1057-1060.
4覃立行,潘靖华,苏家林,等.急性重度有机磷农药中毒行血浆置换联合血液灌流治疗的临床效果以及对炎性因子的影响[J].临床急诊杂志,2016,26(4):286-288.
5朱子扬,龚兆庆,汪国良.中毒急救手册[M].3版.上海:上海科学技术出版社,2007:937-952.
6高茹春,赵建娅,潘爱群,等.急性有机磷农药中毒患者血清及全血胆碱酯酶的相关性研究[J].重庆医学,2016,45(5):648-650.
7廖汉文,朱梦,孟东勇.血液灌流联合血液滤过对治疗急性重度有机磷农药中毒的临床研究[J].中国中西医结合肾病杂志,2016,17(2):137-138.
8钱丽娜.急性重度有机磷农药中毒长托宁联合血液灌流疗法的应用分析[J].湖南中医药大学学报,2016,24(A02):1333.
9王飞.长托宁对急性有机磷农药中毒患者血气分析、心肌酶谱及炎症因子的影响[J].中国急救复苏与灾害医学杂志,2017,12(10):1007-1010.
10陆伟荣,吴先正.血必净对有机磷中毒血液灌流患者的治疗效果及作用机制[J].山东医药,2017,57(24):94-96.
11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(8):495-498.
12蔡雪,刘鑫,韩雪,等.血液灌流联合长托宁对急性有机磷中毒患者血清高敏C反应蛋白和白细胞介素-18的影响[J].疑难病杂志,2017,16(6):596-599.
13侯景玉,吴畏,陈希妍,等.序贯性血液净化治疗急性重度有机磷农药中毒并发多器官功能障碍综合征疗效观察[J].新乡医学院学报,2016,33(2):126-129.
14王永田,赵永芳,高三花,等.急性有机磷农药中毒患者血清心肌酶谱变化[J].河北医药,2016,38(17):2592-2594.
15 Liu L,Ding G.Effects of different blood purification methods on serum cytokine levels and prognosis in patients with acute severe organophosphorus pesticide poisoning[J].Ther Apher Dial,2015,19(2):185-190.
16田应海,陈秋霞,邓小莹,等.血必净注射液对重度急性有机磷农药中毒患者血清CRP、TNF-α及IL-6水平的影响[J].中成药,2017,39(7):1365-1368.
17 Yesilbas O,Kihtir HS,Altiti M,et al.Acute severe organophosphate poisoning in a child who was successfully treated with therapeutic plasma exchange,highvolume hemodiafiltration,and lipid infusion[J].J Clin Apher,2016,31(5):467-469.
18 Kovalevsky A,Blumenthal DK,Cheng X,et al.Limitations in current acetylcholinesterase structure:based design of oxime antidotes for organophosphate poisoning[J].Ann N Y Acad Sci,2016,1378(1):41-49.
19 Reji KK,Mathew V,Zachariah A,et al.Extrapyramidal effects of acute organophosphate poisoning[J].Clin Toxicol(Phila),2016,54(3):259-265.
20 Lin JN,Lin CL,Lin MC,et al.Increased risk of dementia in patients with acute organophosphate and carbamate poisoning:a nationwide Population-Based cohort study[J].Medicine(Baltimore),2015,94(29):el187.
21 Lee FY,Chen WK,Lin CL,et a1.Organophosphate poisoning and subsequent acute kidney injury risk:a nationwide Population-Based cohort study[J].Medicine(Baltimore),2015,94(47):2107.
22 Duta P,Kamath SS,Bhlala A,et al.Effects of acute organophosphate poisoning on pituitary target gland hormones at admission,discharge and three months after poisoning:A hospital based pilot study[J].Indian JEndoerinol Metab,2015,19(1):116-123.