早期持续血液净化对有机磷中毒患者血清肿瘤坏死因子α、白细胞介素8及白细胞介素18水平影响  

Early Application of Continuous Blood Purification on Inflammatory Cytokines Tumor Necrosis Factor-α,Interleukin-8,Interleukin-18 Levels of Organophosphate Poisoned Patients

作　　者：焦清海[1] 王健[1] 张雪梅[1] 葛海江[1] 王莎[1] 王帅[1] 张文忠[1] 张智斌[1] 

机构地区：[1]邯郸市第一医院重症医学科,河北邯郸056002

出　　处：《临床误诊误治》2016年第8期94-97,共4页Clinical Misdiagnosis & Mistherapy

基　　金：河北省科技计划项目(122777137)

摘　　要：目的观察早期持续血液净化对有机磷中毒患者血清肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、白细胞介素8(interleukin-8,IL-8)及白细胞介素18(interleukin-18,IL-18)水平影响。方法选择2013年1月—2015年10月在邯郸市第一医院就诊的84例有机磷中毒,随机将其分为观察组44例和对照组40例,在常规治疗基础上,观察组接受早期持续血液净化联合血液灌流治疗,对照组接受早期血液灌流治疗,观察比较两组临床疗效指标、血清炎性因子及并发症发生率、存活率情况。结果观察组阿托品用量明显少于对照组,胆碱酯酶活性恢复时间、昏迷持续时间、住院总时间均明显短于对照组,差异均有统计学意义(P<0.05)。治疗后1 d两组血清TNF-α、IL-8及IL-18水平均较治疗前明显升高,治疗后3、5 d两组血清TNF-α、IL-8及IL-18水平均较治疗前明显降低,差异均有统计学意义(P<0.05)。治疗后1、3、5 d,观察组血清TNF-α、IL-8及IL-18水平均明显低于对照组,差异均有统计学意义(P<0.05)。治疗后1周观察组低氧血症、呼吸衰竭、肝损伤及肾损伤等并发症发生率均明显低于对照组,发病后30 d观察组存活率明显高于对照组,差异均有统计学意义(P<0.05)。结论有机磷中毒患者早期应用持续血液净化可促进体内胆碱酯酶恢复活性,减少药物用量,缓解机体炎症状态,从而降低并发症发生率,提高生存率。Objective To study the effect of early application of continuous blood purification on inflammatory cytokines tumor necrosis factor-α（ TNF-α）,interleukin-8（ IL-8）,interleukin-18（ IL-18） levels of organophosphate poisoned patients.Methods 84 patients with organophosphate poisoning admitted to the First Hospital of Handan during January 2013 and October2015 were divided into observation group（ n = 44） and control group（ n = 40）. The observation group on the basis of conventional therapy received early continuous blood purification and hemoperfusion,and the control group on the basis of conventional therapy received hemoperfusion according to different treatment methods. Then the clinical efficacy index,serum inflammatory factors,survival rate and incidence of complications were compared between the two groups. Results The observation group＇s atropine dosage was significantly less than that of the control group,cholinesterase activity recovery time,coma duration time,hospitalization time were significantly shorter than that of the control group（ P 0. 05）. On 1 d after treatment,levels of TNF-α,IL-8 and IL-18 of the two groups were significantly higher than those before treatment. On 3,5 d after treatment,levels of TNF-α,IL-8 and IL-18 of the two groups were significantly lower than that before treatment,and the differences were statistically significant（ P 0. 05）. On 1,3,5 d after treatment,levels of TNF-α,IL-8 and IL-18 of the observation group were significantly lower than that of the control group,and the differences were statistically significant（ P 0. 05）. Hypoxemia,respiratory failure,liver damage and kidney damage of the observation group were significantly lower than that of the control group after1 week of treatment,the survival rate was significantly higher than that of the control group 30 days after the onset,and the difference was statistically significant（ P 0. 05）. Conclusion The early application of continuous blood purification technology helps to promote t

关 键 词：有机磷化合物 中毒 持续血液净化 肿瘤坏死因子Α 白细胞介素8 白细胞介素18 

分 类 号：R595.4[医药卫生—内科学]