郑玥,谢佳,马宇,张显红
ZHENG Yue,XIE Jia,MA Yu,ZHANG Xianhong

• 1:重庆市第五人民医院急诊科
• 2:第三军医大学附属西南医院急救部
• 3:重庆市第五人民医院神经内科

摘要(Abstract)：

目的:观察血液灌流(HP)对急性有机磷农药中毒(AOPP)中间综合征(IMS)的治疗效果。方法:80例AOPP-IMS患者随机均分为对照组和观察组,对照组给予洗胃、解毒剂、机械通气等常规内科综合治疗,观察组在对照组治疗的基础上、于入院3 h内给予HP治疗;比较2组患者治疗前、治疗1 d及2 d时的血液胆碱酯酶(Ch E)活性,治疗前及治疗2 d时血液中的敌敌畏及氧化乐果浓度,比较2组患者昏迷持续时间、阿托品化时间、住院时间,观察2组患者病情转归、IMS持续时间及生存情况。结果:治疗前,2组患者血液Ch E活性、血液敌敌畏及氧化乐果浓度比较,差异无统计学意义(P>0.05);治疗1 d及2 d时,2组患者血液Ch E活性显著高于治疗前,观察组高于对照组(P<0.05),观察组患者昏迷时间、阿托品化时间及住院时间分别低于对照组(P<0.05);治疗2 d时2组患者血液敌敌畏、氧化乐果浓度均较治疗前均有显著下降,观察组下降幅度较对照组更为显著(P<0.05);观察组患者存活率100%(40/40),对照组有3例患者因多脏器衰竭死亡、存活率92.50%(37/40),2组比较差异无统计学意义(P>0.05);观察组IMS持续时间显著短于对照组(P<0.05)。结论:HP有助于清除AOPP-IMS患者体内的有机磷和提高Ch E活性,对缩短病程和促进病情转归具有重要意义。
Objective: To observe the therapeutic effects of Hemoperfusion( HP) and conventional internal medicine in the treatment of intermediate syndrome( IMS) of acute organophosphorus pesticide poisoning( AOPP) so as to optimize the clinical treatment. Methods: 80 patients with AOPP-IMS were collected in the department of emergency of our hospital from May 2014 to May 2015. The patients were randomly divided into the control group and the observation group,with 40 cases each. The control group was given conventional treatment including gastric lavage,antidote,mechanical ventilation and so on. The observation group received HP based on the treatment for the control group. The changes in the activity of cholinesterase( Ch E),the time of coma,atropine time,the time of hospitalization,the change of the concentration of organophosphorus poison and the prognosis of the outcome were compared between the 2 groups. Results: The blood Ch E activity in the 2 groups increased significantly( P < 0. 05),but the activity of Ch E in the observation group was significantly higher than that in the control group( P < 0. 05). The time of coma,atropine time and the time of hospitalization in the observation group were lower than those of the control group,and the concentration of organophosphorus toxic substances in the blood liquid was significantly lower than that of the control group after the treatment of 2 D. The difference was statistically significant( P < 0. 05); the survival rate of the2 groups was not significantly different( P > 0. 05),but the duration of IMS in the observation group was significantly lower than that of the control group,and the difference was statistically significant( P< 0. 05). Conclusions: HP can help to eliminate the organic phosphorus and improve the activity of Ch E in patients with AOPP-IMS. It is of great significance in shortening the course of disease and promoting the prognosis of the patients.

关键词(KeyWords)： 中毒;有机磷农药;中间综合征;血液灌流;疗效
poisoning;organophosphorus pesticide;intermediate syndrome;hemoperfusion;curative effect

Abstract:

Keywords:

基金项目(Foundation): 重庆市南岸区区科委课题资助[南岸科委发(2014)6号]

作者(Author): 郑玥,谢佳,马宇,张显红
ZHENG Yue,XIE Jia,MA Yu,ZHANG Xianhong

DOI: 10.19367/j.cnki.1000-2707.2018.08.024

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