活性炭血液灌流治疗急性重度敌敌畏中毒的实验研究  

Therapeutic effects of hemoperfusion with coated activated charcoal in acute dichlorvos pesticide poisoning： experiment with dogs

作　　者：汤雪萍[1] 张锡刚[1] 何跃忠[1] 

机构地区：[1]军事医学科学院附属医院急诊科,北京100071

出　　处：《中国急救复苏与灾害医学杂志》2009年第2期81-84,共4页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的探讨活性炭血液灌流（HPA）治疗在急性重度敌敌畏中毒救治中的作用。方法通过静脉推注敌敌畏（100mg／kg）染毒比格犬，并将其随机分成对照组（常规治疗）和HPA组（HPA＋常规治疗）各5只，动态检测两组犬血浆中敌敌畏浓度、丁酰胆碱酯酶（BuChE）活力的变化，并观察治疗效果。结果炭肾对血中敌敌畏的相对清除率高达（87．15±15．69）％。静脉推注敌敌畏后，2组间血中敌敌畏浓度迅速下降，仅HPA治疗后0．5～2hHPA组血浆中敌敌畏浓度明显低于对照组（P〈0．05），但此后2组间敌敌畏浓度无显著性差异（P〉0．05）。在染毒后的24h内，2组间BuChE活力无显著性差异（P〉0．05）。临床观察阿托品用量、出现呼吸衰竭时间和辅助呼吸时间等，2组间差异无统计学意义（均P〉0．05）。每组各死亡1只。结论虽然应用HPA治疗可明显降低血毒浓度，但仅能清除体内毒物负荷量的一小部分，在BuChE活力的恢复、硫酸阿托品的用量等方面未见到明显影响。Objective To investigate the effects of hemoperfusion with coated activated charcoal in treatment of acute severe diehlorvos poisoning. Methods Ten beagles underwent intravenous injection of dichlorvos 100 mg/kg and then randomly divided into 2 equal groups： conventional detoxication drug group （Group A） undergoing atropinization by intravenous injection of atropine and intramuscular injection of pralidoxime chloride, and conventional detoxication drug＋ hemoperfusion with coated activated charcoal group （Group B） undergoing atropinization and intramuscular injection of pralidoxime chloride and hemoperfusion of coated active charcoal since 1 hour after dichlorvos injection in addition. Peripheral blood samples were collected at different time points to measure the dichlorvos concentration and butyryleholinesterase （BuChE） activity. Results 0.5 hour after hemoperfusion the relative clearance rate of dichlorvos in the blood of Group B was （87.88±4.89）%. The blood diehlorvos concentration significantly decreased 1 hour after the dichlorvos injection in both groups. During the period of 0.5-2 hours after hemoperfusion the blood dichlorvos concentrations of Group B were all significantly lower than those of Group A （all P〈0.05）, however, since then there was no significant differences in the blood dichlorvos concentrations at any time point between these 2 groups （all P〉0.05）. 0.5 hour after the dichlorvos injection the blood BuChE activity levels of the 2 groups were both significantly lower than those before the injection （both P〈0.05）. 24 hours after treatment the blood BuChE concentrations of the 2 groups basically returned to the baseline levels without significant difference between them （P〉0.05）. There were not significant differences in the cumulative dosage of atropine required, onset time of respiratory failure, and time needed for assisting-respiration between these 2 groups （all P〉0.05）. One dog from each group, totally 2, died of circulatory failure. Concl

关 键 词：血液灌流 急性中毒 有机磷农药 

分 类 号：R539[医药卫生—内科学]