不同血液灌流策略对重度急性有机磷农药中毒患者胆碱酯酶活力的影响  

Effects of different hemoperfusion strategies on cholinesterase activity insevere acute organophosphorus pesticide poisoning patients

作　　者：吴嘉荔[1] 冀晓静 李博[1] 杨立山[1] Wu Jiali;Ji Xiaojing;Li Bo;Yang Lishan(Emergency Department,General Hospital ofNingxia Medical University,Tinchuan,China;Department of Laboratory1 Medicine,the 942nd Hospital of Joint Logistics Support Force of PLA,Tinchuan,China)

机构地区：[1]宁夏医科大学总医院急诊科,银川750004 [2]联勤保障部队第942医院检验科,银川750004

出　　处：《中华急诊医学杂志》2021年第3期272-277,共6页Chinese Journal of Emergency Medicine

基　　金：北京协和医学基金-睿E(睿意)急诊医学研究专项基金(R2018030)。

摘　　要：目的探讨不同血液灌流(hemoperfusion,HP)次数对重度急性口服有机磷农药中毒(acute organophosphorus pesticide poisoning,AOPP)患者血清胆碱酯酶(cholinesterase,ChE)恢复的影响。方法本研究为回顾性病例对照研究,通过收集2010年1月至2019年12月收治的重度AOPP患者临床资料,记录患者入院时、治疗后第1、3、5天ChE活力水平,以及患者性别、年龄、口服毒物量等相关资料,通过广义估计方程及事后多重比较分析未行HP的患者以及不同HP治疗次数对AOPP患者ChE的影响。结果本研究最终纳入159例患者,其中男性60例(37.74%),女性99例(62.26%)。年龄中位数为33岁(范围13~75岁)。有机磷农药口服量中位数为75 mL(范围15~500 mL)。多因素分析结果显示,在未调整的广义估计方程中,单次HP治疗AOPP患者较未行HP治疗的患者ChE水平高745.6 U/L(95%CI:467.09~1024.1;P<0.01),2次HP治疗者较未行HP者ChE水平高565.81 U/L(95%CI:384.25~747.36;P<0.01),3次HP治疗者较未行HP者ChE水平高743.86 U/L(95%CI:420.71~1067.01;P<0.01),其差异均有统计学意义。调整入院时口服毒物量、年龄及中毒严重度评分(poisoning severity score,PSS)后的多个广义估计方程结果提示,无论是单次HP治疗还是多次HP治疗,AOPP患者ChE的恢复速度均较未行HP治疗的患者快,其差异均具有统计学意义。而多个模型的多重比较结果显示,3次HP治疗和1~2次的HP治疗相比其差异并无统计学意义,2次HP治疗和1次HP治疗相比,其平均差值亦无统计学意义。结论HP治疗可加快AOPP患者ChE的恢复速度;单次和多次HP治疗对AOPP患者ChE恢复速度影响无差异。Objective To explore the effect of different hemoperfusion times on the recovery of serum cholinesterase(ChE)in patients with severe acute oral organophosphorus pesticide poisoning(AOPP).M ethods This was a retrospective case-control study.Patients with severe AOPP admitted to our hospital were identified between January 2010 and December 2019.The clinical information of patients with severe AOPP was collected between January 2010 and December 2019,the patient's ChE vitality levels were collected on admission,at 1,3 and 5 days after admission,and the sex,age,oral poison volume,and related treatments were recorded as well.The relationship between ChE,different HP treatment times and patients without HP treatment was analyzed by generalized estimation equations and multiple comparisons afterward.Results A total of 159 patients with severe AOPP were included in our study.Among them,60(37.74%)patients were male and 99(62.26%)were female,with a median age of 33 years old(range 13-75 years old).The median oral dose of OPs was 75 mL(range 15-500 mL).Multivariate analysis results showed that in the unadjusted generalized estimation equation,compared with patients without HP treatment,the average ChE value of patients with single HP treatment was 745.6 U/L higher(95%CI:467.09-1024.1;P<0.01),the average ChE value of patients with 2 times HP treatment was 565.81 U/L higher(95%CI:384.25-747.36;P<0.01),and the average ChE value of patients with 3 times HP treatment was 43.86 U/L higher(95%CI:420.71-1067.01;P<O.O1),the differences were all statistically significant.After adjusting the amount of oral OPs at admission,age and PSS score in the multiple generalized estimation equations,the results showed that whatever single HP treatment or multiple HP treatment,the recovery rate of ChE was significantly faster than those without HP treatment.And the multiple comparison results of multiple models showed that the difference between 3 times HP treatment and 1 to 2 times HP treatment was not statistically significant,and the average

关 键 词：有机磷农药中毒 血液灌流 胆碱酯酶 

分 类 号：R595.4[医药卫生—内科学]