血液灌流联合血浆置换治疗急性重度有机磷农药中毒合并呼吸衰竭的疗效研究  

Hemoperfusion combined with plasma exchange for the treatment of acute severe organophosphorus pesticide poisoning with respiratory failure

作　　者：牛家杰 安小峰[1] 胡守芹 NIU Jiajie;AN Xiaofeng;HU Shouqin(Department of Emergency,General Hospital of North Anhui Coal Power Group,Suzhou 234000,China)

机构地区：[1]皖北煤电集团总医院急诊科,安徽宿州234000

出　　处：《中国急救复苏与灾害医学杂志》2020年第9期1070-1073,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：安徽省自然科学基金项目(编号:1308085QH134)。

摘　　要：目的观察血液灌流联合血浆置换治疗急性重度有机磷农药中毒合并呼吸衰竭的疗效.方法选取皖北煤电集团总医院2017年1月—2019年12月收治80例急性重度有机磷农药中毒合并呼吸衰竭患者,按入院顺序分为三组:常规治疗组(26例)、血液灌流组(27例)及血液灌流联合血浆置换组(联合组,27例).常规治疗组接受常规急救及治疗措施,在此基础上,血液灌流组接受血液灌流治疗,联合组接受血液灌流联合血浆置换治疗.观察三组治疗后疗效、胆碱酯酶、炎症因子、并发症及呼吸功能变化.结果联合组治愈率高于常规治疗组(P<0.05),阿托品总用量、氯解磷定总用量低于血液灌流组和常规治疗组(P<0.05),昏迷时间、住院时间短于血液灌流组和常规治疗组(P<0.05).治疗前三组胆碱酯酶、TNF-α、IL-6、IL-1β、PaO2、PaO2/FIO2差异无统计学意义(P>0.05),治疗后,联合组胆碱酯酶、PaO2、PaO2/FIO2水平高于血液灌流组和常规治疗组(P<0.05),TNF-α、IL-6、IL-1β低于血液灌流组和常规治疗组(P<0.05);血液灌流组胆碱酯酶、PaO2、PaO2/FIO2高于常规治疗组(P<0.05),TNF-α、IL-6、IL-1β低于常规治疗组(P<0.05).三组治疗期间中间综合征、肝损伤、肾损伤、消化道出血、肺部感染等发生率差异无统计学意义(P>0.05).结论血液灌流联合血浆置换治疗急性重度有机磷农药中毒合并呼吸衰竭效果显著,可提高疗效及胆碱酯酶水平,改善呼吸功能,降低炎症水平,且并发症发生率低,安全性高.Objective To observe the ffectls of hemoperfusion combined w ith plasma exchange on acute severe organo-phosphorus pesticide poisoning combined with respiratory failure.Methods 80 patients with acute and severe organo-phosphorus pesticide poisoning and respiratory failure were randomly divided into 3 groups according to the order of admission:conventional treatment group(n=26)receiving routine first aid and treatment measures,hemoperfusion group(n=27)receiving hemoperfusion in addiction,and hemoperfusion combined with plasma exchange group(combined group,n=27)receiving hemoperfusion and plasma exchange treatment in addition.The curative ffeet was observed.Five days after admission peripheral venous blood samples were collected to test the levels of cholinesterase(CHE),inlammatory factors,ie.tumor neerosis factor-a(TNF-a),Interleukin-1 beta(IL-1β),and IL-6,by immunoturbidime-try.Results The cure rate of the combined group was higher than that of the conventional treatment group(P<0.05).The coma time and hospital stay of the combined group were significantly shorter than those of the hemoperfusion group and the conventional treatment group(all P<0.05).The total amounts of used atropine and chlorhexidine of the combined group and hemoperfusion group were all significantly lower than those of the conventional treatment group(all P>0.05).There were no significant differences in the levels of CHE,TNF-a,IL-6,L-1β.PaO2,and Pa O/FI02 among these 3 groups before treatment(all P>0.05).After treatment,the CHE levels of the 3 groups all significantly inereased(all P<0.05).The CHE level afer treatment of the combined group was signifcantly higher than those of the other 2 groups(both P>0.05),and the CHE level of the hemoperfusion group was si gnificantly higher than that of the conventional treatment groups(P>0.05).The PaO2 and PaO/FI O2 levels after treatment of the 3 groups were all higher than those be-fore treatment(all P<0.05).The PaO2 and PaO/FI 02 levels after treatment of the combined group were significantly higher

关 键 词：血液灌流 血浆置换 急性重度有机磷农药中毒 呼吸衰竭 

分 类 号：R459.7[医药卫生—急诊医学]