盐酸戊乙奎醚注射液联合血液灌流对重症急性有机磷中毒患者症状改善及心肌酶谱水平的影响  

Effects of penehyclidine hydrochloride injection combined with hemoperfusion on symptom improvement and myocardial enzymes in patients with severe acute organophosphorus poisoning

作　　者：张素杰 李登辉 马玉亮 Zhang Su-jie;Li Deng-hui;Ma Yu-liang(Department of Emergency,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院急诊科,河南郑州450000

出　　处：《四川生理科学杂志》2023年第7期1171-1174,共4页Sichuan Journal of Physiological Sciences

摘　　要：目的:探讨盐酸戊乙奎醚(Penehyclidine hydrochloride,PCHE)注射液联合血液灌流(Hemoperfusion,HP)对重症急性有机磷中毒(Acute organophosphate poisoning,AOPP)患者症状改善的影响。方法:选取2020年3月至2021年4月本院收治的77例AOPP患者为研究对象,随机分为单一组(n=38)和联合组(n=39),分别采用HP(首次使用剂量为70 mg,维持剂量为6~8 mg·h-1)治疗以及HP+PCHE治疗。对比分析两组临床疗效、症状改善时间;治疗前、治疗3 d后使用MEB-9200K肌电诱发电位检查仪检测腓总神经运动传导速度(Motor conduction velocity of common peroneal nerve,MCV)、感觉传导速度(Sensory conduction velocity,SCV)、F波潜伏期。治疗前、治疗3 d后采用优化速率法检测乳酸脱氢酶(lacLC3-Ⅱtate dehydrogenase,LDH)、磷酸肌酸激酶同工酶(Creatine kinase and creatine kinase isoenzyme,CK-MB)水平,使用ACCESS全自动微粒子免疫化学发光系统检测心肌肌钙蛋白(Cardiac troponinⅠ,cTnI)水平。治疗前、治疗3 d后采用ELISA法检测血清二胺氧化酶(Diamine oxidase,DAO)、瓜氨酸(Citrulline,Cit)水平,采用高效液相色谱法检测乳果糖(Lactulose,L)、甘露醇(Mannitol,M)含量并计算L/M比值。结果:联合组抢救成功率与单一组无统计学差异(P>0.05),但总有效率高于单一组,症状改善时间短于单一组(P<0.05);治疗后联合组MCV、SCV、Cit水平高于单一组,F波潜伏期、LDH、CK-MB、cTnI、DAO水平、L/M低于单一组(P<0.05)。结论:PCHE联合HP治疗AOPP疗效确切,可改善其临床症状,减轻心肌损伤,促进神经功能、胃肠功能恢复。Objective:To investigate the effect of Penehyclidine hydrochloride(PCHE)injection combined with hemoperfusion(HP)on the improvement of symptoms in patients with severe acute organophosphorus poisoning(AOPP).Methods:Seventy-seven patients with AOPP admitted to our hospital from March 2020 to April 2021 were randomly divided into a single group(n=38)and a combined group(n=39),and treated with HP(70 mg for the first time,6-8 mg·h-1 for maintenance)and HP+PCHE,respectively.The clinical efficacy and symptom improvement time of the two groups were compared and analyzed;The motor conduction velocity of common peroneal nerve(MCV),sensory conduction velocity(SCV),and F wave latency were measured with MEB-9200K myoelectric evoked potential tester before and 3 days after treatment.The levels of lactate dehydrogenase(LDH)and creatine kinase and creatine kinase isoenzyme(CK-MB)were measured by optimized rate method before and 3 days after treatment,and the levels of cardiac troponin I(cTnI)were measured by ACCESS automatic particle immunochemiluminescence system.Serum diamine oxidase(DAO)and citrulline(Cit)levels were detected by ELISA before and 3 days after treatment.Lactulose(L)and mannitol(M)contents were detected by HPLC and L/M ratio was calculated.Results:There was no significant difference in the rescue success rate between the combined group and the single group(P>0.05),but the total effective rate was higher than that of the single group,and the symptom improvement time was shorter than that of the single group(P<0.05).After treatment,the levels of MCV,SCV and Cit in the combined group were higher than those in the single group,while the levels of F wave latency,LDH,CK-MB,cTnI,DAO,and L/M in the combined group were lower than those in the single group(P<0.05).Conclusion:PCHE combined with HP has a definite therapeutic effect on AOPP,which can improve its clinical symptoms,reduce myocardial injury,and promote the recovery of neural function and gastrointestinal function.

关 键 词：急性有机磷中毒 盐酸戊乙奎醚 血液灌流 疗效 心肌酶谱 

分 类 号：R595.4[医药卫生—内科学]