序贯血液净化治疗急性重症有机磷中毒对患者心肌功能的影响  

Effects of sequential blood purification on myocardial function of patients with acute severe organophosphorus poisoning

作　　者：徐小侠 陈敏 XU Xiaoxia;CHEN Min(Department of Emergency,Qingyang Second People's Hospital,Qingyang,Gansu 745000,China)

机构地区：[1]庆阳市第二人民医院急诊科,甘肃庆阳745000

出　　处：《现代医学与健康研究电子杂志》2022年第18期24-28,共5页Modern Medicine and Health Research

摘　　要：目的探讨序贯血液净化治疗急性重症有机磷中毒对患者血清胆碱酯酶(CHE)、神经元特异性烯醇化酶(NSE)、肌酸激酶(CK)、乳酸脱氢酶(LDH)、肌酸激酶同工酶(CK-MB)、缺血修饰白蛋白(IMA)水平的影响。方法以随机数字表法将2019年12月至2021年11月期间于庆阳市第二人民医院就诊的80例急性重症有机磷中毒患者分为对照组(40例)和观察组(40例)。给予所有患者常规急诊治疗,对照组患者在此基础上进行血液灌流治疗,观察组患者在对照组的基础上进行序贯血液净化治疗,两组患者均观察至出院。比较两组患者治疗后的临床疗效、临床指标,治疗前后血清CHE、NSE及心肌损伤标志物水平。结果治疗后观察组患者临床治疗总有效率高于对照组;观察组患者CHE活性恢复时间、昏迷时间、住院时间均短于对照组,阿托品使用剂量少于对照组;治疗后两组患者CHE水平均升高,且观察组较对照组升高;血清NSE、CK、LDH、CK-MB、IMA水平均降低,且观察组较对照组降低(均P<0.05)。结论序贯血液净化可通过提高毒素清除率,快速恢复急性重症有机磷中毒患者血清CHE活性,从而减少阿托品使用量,减轻患者心肌与神经系统的损伤,进而缩短昏迷与住院时间,提升治疗效果。Objective To explore the effects of sequential blood purification on levels of serum cholinesterase(CHE), neuron specific enolase(NSE), creatine kinase(CK), lactate dehydrogenase(LDH), creatine kinase MB isoenzyme(CK-MB) and ischemia modified albumin(IMA) in patients with acute severe organophosphorus poisoning. Methods 80 patients with acute severe organophosphorus poisoning treated in Qingyang Second People’s Hospital from December 2019 to November 2021 were divided into the control group(40 cases) and the observation group(40 cases) by random number table method. Routine emergency treatment was given to all patients, patients in the control group were treated with hemoperfusion on this basis, patients in the observation group were treated with sequential blood purification on the basis of the control group, patients in both groups were observed until discharge. The clinical efcacy, clinical indexes after treatment, levels of serum CHE, NSE and myocardial injury markers before and after treatment were compared between the two groups. Results After treatment,the total effective rate of clinical treatment in the observation group was higher than that in the control group;the recovery time of CHE activity,coma time, hospitalization time in the observation group were shorter than those in the control group, and the dosage of Atropine was less than that in the control group;after treatment, CHE levels in both groups increased, and the observation group was higher than the control group;the levels of serum NSE, CK, LDH, CK-MB and IMA in both groups decreased, and those in the observation group were lower than those in the control group(all P<0.05). Conclusion Sequential blood purification can quickly restore the serum CHE activity of patients with acute severe organophosphorus poisoning by improving the toxin clearance rate, thereby reducing the use of Atropine, reducing the damage of the patient’s myocardial and nervous system, and further shortening the coma and hospitalization time, and improving the treatment

关 键 词：有机磷中毒 序贯血液净化 血液灌流 心肌功能 

分 类 号：R595[医药卫生—内科学]