胃肠道毒物优化清除对重度急性有机磷农药中毒患者疗效的影响  

An effect of gastrointestinal poison elimination optimization on patients with severe acute organophosphorus pesticide poisoning T

作　　者：杨胜[1] 张冬惠[1] 王绍谦[1] 马汤力[1] 葛燕萍[1] 付旭晖 

机构地区：[1]开封市第二人民医院EICU,河南开封475002

出　　处：《中国中西医结合急救杂志》2016年第2期164-167,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：河南省开封市科技发展基金资助项目（100341）

摘　　要：目的观察胃肠道内毒物优化清除（GPEO）在救治重度急性有机磷农药中毒（AOPP）患者中的作用。方法采用回顾性对照研究方法，选择2009年6月至2015年5月河南省开封市第二人民医院急诊重症加强治疗病房（EICU）收治的106例急性重度有机磷农药中毒患者，将入选患者按胃肠道干预治疗不同分为观察组（50例）和对照组（56例）。所有患者均给予了常规治疗，观察组在常规治疗基础上给予了加强胃肠道毒物优化清除，包括留置胃管，72h内每4h1次反复洗胃；每6h1次给予药用活性炭30g和温开水100mL搅拌成的混悬液鼻饲；生大黄粉10～20g鼻饲或保留灌肠，疗程均为10d。比较两组患者胆碱酯酶（ChE）活性恢复50％的时间、阿托品平均用量、中间期综合征发生率、呼吸机使用天数、28d迟发型多发性神经病发生率、28d病死率，总住院时间及总住院费用。结果观察组治疗后胆碱酯酶活性恢复50％时间（h：61．6±12．6比76．6±15．4）、呼吸机使用天数（d：3．6±2．3比7．8±3．9）、总住院时间（d：18．1±3．9比31．3±4．8）均较对照组缩短，阿托品用量（nag：418．9±128．8比567．6±161．7）、中间期综合征发生率[20．0％（10／50）比37．5％（21／56）]、迟发型多发性神经病发生率[14．0％（7／50）比30．4％（17／56）]、28d病死率[8．0％（4／50）比25．O％（14／56）]、住院总费用（万元：1．90±0．52比2．80±0．76）均较与对照组明显减少，差异均有统计学意义（P〈0．05或P〈0．01）。结论GPEO救治AOPP患者，能最大限度地减少胃肠道内残留毒物再吸收，改善器官功能，提高抢救成功率，改善预后，也节约了医疗资源。Objective To investigate the clinical therapeutic effects of gastrointestinal poison elimination optimization （GPEO） for saving patients with severe acute organophosphorus pesticide poisoning （AOPP）. Methods A retrospective control study was conducted, including 106 patients with severe AOPP admitted to the Department of Emergency Intensive Care Unit of the Second People＇s Hospital of Kaifeng City from January 2009 to February 2015. According to the difference in intervention methods of gastrointestinal tract, the patients were divided into observation group （50 cases） and control group （56 cases）. All patients in both groups were given routine therapy, the observation group additionally was given strengthen GPEO treatment, including indwell gastrotube, repeated gastric lavage 4 hours once within 72 hours, and nasogastrie feeding of medically used activated carbon 30 g dissolved in 100 mL water as a suspension fluid, once every 6 hours, moreover, nasal feeding or retention-enema of raw rhubarb powder 10-20 g was applied, the therapeutic course being 10 days. After treatment, 50% cholinesterase activity recovery time, calculation of the average dosage of atropine used for intoxicated patients, the incidence of intermediate period syndrome, the number of days for using mechanical ventilation, the incidence of delayed polyneuropathy in 28 days, 28-day mortality, total expenses and duration for hospitalization were observed in the two groups. Results Compared with the control group, the recovery time of eholinesterase activity to its 50% （hours： 61.6 ± 12.6 vs. 76.6± 15.4）, days used for ventilator （days： 3.6± 2.3 vs. 7.8 ± 3.9）, and the total hospitalization time （days： 18.1± 3.9 vs. 31.3 ± 4.8） were shortened significantly in observation group, the average dosage of atropine used （mg： 418.9±128.8 vs. 567.6± 161.7）, the incidence of intermediate period syndrome [20.0% （10/50） vs. 37.5% （21/56）], and the incidence of delayed polyneuropathy [14.0% （7/50） vs

关 键 词：有机磷农药中毒 重度中毒 胃肠道毒物优化清除 预后 临床研究 

分 类 号：R595.4[医药卫生—内科学]