血液灌流联合阿托品治疗有机磷农药中毒临床疗效研究
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摘要
目的探讨血液灌流联合阿托品治疗有机磷农药中毒的临床疗效。方法选取自2013年1月至2017年12月收治的急性有机磷农药中毒患者64例,患者均行洗胃、导泻、药用活性炭吸附等方式进行消化道清洗的常规治疗。其中,A组患者给予阿托品治疗(n=32),B组患者给予阿托品联合血液灌流治疗(n=32)。记录并比较两组患者临床疗效、意识恢复时间、阿托品用量、住院时间、并发症情况、病死率,以及治疗前与治疗后3、7 d肌酸激酶同工酶、胆碱酯酶、心肌肌钙蛋白I水平。结果 B组患者总有效率为93.8%(30/32),显著高于A组的75.0%(24/32),差异有统计学意义(P<0.05)。A组患者病死率为12.5%(4/32),B组患者病死率为6.3%(2/32),差异无统计学意义(P>0.05)。B组患者意识恢复时间、住院时间明显短于A组,且阿托品用量少于A组,差异均有统计学意义(P<0.05)。B组患者迟发性神经损害、中间综合征、中毒性肝损害及反跳的发生率均明显低于A组,差异有统计学意义(P<0.05)。B组患者胆碱酯酶恢复时间明显短于A组;治疗后,两组患者胆碱酯酶活性均较入院时升高,且B组高于A组,差异均有统计学意义(P<0.05)。治疗后,两组患者肌酸激酶同工酶、心肌肌钙蛋白I水平均较入院时明显降低,且B组低于A组,差异均有统计学意义(P<0.05)。结论血液灌流联合阿托品治疗有机磷农药中毒疗效显著,可明显降低并发症的发生率。
Objective To investigate the effect of hemoperfusion combined with atropine on organophosphorus pesticide poisoning.Methods A retrospective study was performed on 64 cases of patients with acute organophosphorus pesticide poisoning who were admitted from January 2013 to December 2017.All the patients received routine treatment of digestive tract cleaning by gastric lavage,catharsis and active carbon adsorption.Patients in Group A were treated with atropine(n=32),while patients in Group B were treated with atropine combined with hemoperfusion(n=32).Clinical efficacy,time of consciousness recovery,atropine dosage,length of stay,complications,mortality,and levels of creatine kinase isoenzyme,cholinesterase and cardiac troponin I before and 3 days,7 days after treatment were recorded and compared in the two groups.Results The total effective rate of Group B was 93.8%(30/32),significantly higher than 75.0%(24/32)of Group A,and the difference was statistically significant(P<0.05).The fatality rate was 12.5%(4/32)in Group A and 6.3%(2/32)in Group B,with no statistically significant difference(P>0.05).The recovery time and hospitalization time of patients in Group B were significantly shorter than those in Group A,and the atropine dosage was less than that in Group A(P<0.05).The incidence of delayed nerve injury,intermediate syndrome,toxic liver injury and rebound in Group B was significantly lower than that in Group A(P<0.05).The recovery time of cholinesterase in Group B was significantly shorter than that in Group A.After treatment,the activity of cholinesterase was increased in both groups compared with that at admission,and in Group B was higher than that in Group A(P<0.05).After treatment,the levels of creatine kinase isoenzyme and cardiac troponin I in both groups were significantly lower than those at admission,and the level of Group B was lower than that of Group A(P<0.05).Conclusion The efficacy of hemoperfusion combined with atropine in the treatment of organophosphorus pesticide poisoning is significant,and the complications are significantly reduced.
Objective To investigate the effect of hemoperfusion combined with atropine on organophosphorus pesticide poisoning.Methods A retrospective study was performed on 64 cases of patients with acute organophosphorus pesticide poisoning who were admitted from January 2013 to December 2017.All the patients received routine treatment of digestive tract cleaning by gastric lavage,catharsis and active carbon adsorption.Patients in Group A were treated with atropine(n=32),while patients in Group B were treated with atropine combined with hemoperfusion(n=32).Clinical efficacy,time of consciousness recovery,atropine dosage,length of stay,complications,mortality,and levels of creatine kinase isoenzyme,cholinesterase and cardiac troponin I before and 3 days,7 days after treatment were recorded and compared in the two groups.Results The total effective rate of Group B was 93.8%(30/32),significantly higher than 75.0%(24/32)of Group A,and the difference was statistically significant(P<0.05).The fatality rate was 12.5%(4/32)in Group A and 6.3%(2/32)in Group B,with no statistically significant difference(P>0.05).The recovery time and hospitalization time of patients in Group B were significantly shorter than those in Group A,and the atropine dosage was less than that in Group A(P<0.05).The incidence of delayed nerve injury,intermediate syndrome,toxic liver injury and rebound in Group B was significantly lower than that in Group A(P<0.05).The recovery time of cholinesterase in Group B was significantly shorter than that in Group A.After treatment,the activity of cholinesterase was increased in both groups compared with that at admission,and in Group B was higher than that in Group A(P<0.05).After treatment,the levels of creatine kinase isoenzyme and cardiac troponin I in both groups were significantly lower than those at admission,and the level of Group B was lower than that of Group A(P<0.05).Conclusion The efficacy of hemoperfusion combined with atropine in the treatment of organophosphorus pesticide poisoning is significant,and the complications are significantly reduced.
引文
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[10] 强浩,安小峰,解岗,等.血浆置换联合血液灌流治疗急性重度有机磷农药中毒的疗效及对患者肝功能的影响[J].现代生物医学进展,2018,18(13):2575-2578.
[11] 晁永峰.血液灌流联合消化道清洗在重度有机磷农药中毒中的应用[J].社区医学杂志,2017,15(21):29-30.
[12] 梁德金,李峥,梁裕积.BNP在有机磷农药中毒患者病情早期评估中的作用[J].中国医药指南,2017,15(10):184-185.
[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(5):52-54.
[14] 鲁永和,周马,符艳松.急性有机磷农药中毒患者血清肌酸激酶同工酶和肌钙蛋白I的变化及临床意义[J].河北医药,2016,38(13):2045-2047.
[15] 何华晋.急诊有机磷农药中毒应用还原型谷胱甘肽治疗的效果研究[J].中外医学研究,2016,14(31):157-158.
[2] 张亚佳,李忠海.果蔬中有机磷农药残留检测方法研究进展[J].食品与机械,2016,32(2):173-177,182.
[3] 杨琴,田仰华,周姝,等.急性中重度有机磷农药中毒对认知功能的影响[J].中国全科医学,2016,19(27):3296-3299.
[4] 张宇飚.血液灌注治疗对有机磷农药中毒患者细胞因子及血小板指标的影响观察[J].医学理论与实践,2016,29(20):3461-3462,3469.
[5] 王桂杰.血液灌流联合血液透析对急诊重症有机磷农药中毒患者预后的影响[J].临床医药文献电子杂志,2017,4(10):1842,1844
[6] 徐曙霞,孙虎.血液灌流与长托宁、阿托品治疗重症有机磷中毒的临床分析[J].临床医学研究与实践,2017,2(32):58-59.
[7] 董建辉,李海滨,孙煦勇,等.有机磷中毒供肾移植的效果评价[J].中国组织工程研究,2016,20(29):4311-4318.
[8] 王二宁,王永升.血液灌流治疗急性有机磷中毒患者124例疗效观察[J].陕西医学杂志,2016,45(12):1611-1612.
[9] 廖兆鹏.血液灌流联合血液透析治疗重症有机磷农药中毒的临床分析[J].医学理论与实践,2017,30(11):1640-1642.
[10] 强浩,安小峰,解岗,等.血浆置换联合血液灌流治疗急性重度有机磷农药中毒的疗效及对患者肝功能的影响[J].现代生物医学进展,2018,18(13):2575-2578.
[11] 晁永峰.血液灌流联合消化道清洗在重度有机磷农药中毒中的应用[J].社区医学杂志,2017,15(21):29-30.
[12] 梁德金,李峥,梁裕积.BNP在有机磷农药中毒患者病情早期评估中的作用[J].中国医药指南,2017,15(10):184-185.
[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(5):52-54.
[14] 鲁永和,周马,符艳松.急性有机磷农药中毒患者血清肌酸激酶同工酶和肌钙蛋白I的变化及临床意义[J].河北医药,2016,38(13):2045-2047.
[15] 何华晋.急诊有机磷农药中毒应用还原型谷胱甘肽治疗的效果研究[J].中外医学研究,2016,14(31):157-158.
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