树脂血液灌流在急性有机磷农药中毒救治中的应用及对ChE活力变化、CRP、WBC及NEUT水平的影响  

Application of resin hemoperfusion in the treatment of acute organophosphorus pesticide poisoning and its effects on ChE activity,CRP,WBC and NEUT

作　　者：闫敏[1] 杨一红 蔡晓培 YAN Min;YANG Yi-hong;CAI Xiao-pei(Department of Emergency,Fuyang People's Hospital,Fuyang Anhui 236000,China)

机构地区：[1]阜阳市人民医院急诊科,安徽阜阳236000

出　　处：《临床和实验医学杂志》2023年第17期1865-1869,共5页Journal of Clinical and Experimental Medicine

基　　金：安徽省级临床重点专科建设项目(编号:皖卫医秘[2022]91号);安徽省医学会急诊临床研究项目(编号:Ky2021019)。

摘　　要：目的探究树脂血液灌流在急性有机磷农药中毒(AOPP)救治中的应用及对胆碱酯酶(ChE)活力变化、C-反应蛋白(CRP)、白细胞计数(WBC)及中性粒细胞百分比(NEUT)水平的影响。方法前瞻性选取2019年11月至2022年9月阜阳市人民医院收治的70例重度AOPP患者,并按照随机数字表法分为对照组和观察组,每组各35例。对照组给予洗胃、导泻、应用解毒剂等常规治疗,观察组在对照组基础上应用树脂血液灌流。比较两组治疗情况、ChE活力恢复时间及其水平变化、炎症指标及并发症发生情况。结果观察组患者昏迷时间、住院时间分别为(3.21±1.08)h、7 d,均少于对照组[(3.87±1.15)h、10 d],治愈率为97.14%,高于对照组(82.86%),差异均有统计学意义(P<0.05)。两组患者治疗后1、3、5 d的ChE水平均高于治疗前,且呈逐渐升高趋势(P<0.05),观察组患者治疗后1、3、5 d的ChE水平分别为(672.43±93.28)、(1416.59±150.32)、(3214.28±193.16)U/L,均高于对照组[(629.26±106.41)、(1148.65±141.57)、(3095.47±185.62)U/L],且观察组ChE活力恢复时间为(6.08±1.01)d,短于对照组[(6.85±1.23)d],差异均有统计学意义(P<0.05)。与治疗前比,两组患者治疗后CRP、WBC、NEUT水平均降低,且观察组治疗后上述指标水平分别为(12.73±3.02)mg/L、(11.37±3.36)×10^(9)/L、(72.05±5.54)%,均低于对照组[(15.08±3.26)mg/L、(13.12±3.09)×10^(9)/L、(73.76±4.61)%],差异均有统计学意义(P<0.05)。观察组治疗后中间综合征、反跳发生率分别为2.86%、0,均低于对照组(20.00%、11.42%),差异均有统计学意义(P<0.05)。结论树脂血液灌流可明显缩短AOPP患者昏迷及住院时间,提高患者治愈率,加快ChE活力恢复速度,降低血清CRP、WBC及NEUT水平,减轻患者氧化应激及炎症反应,降低并发症发生风险。Objective To explore the application of resin hemoperfusion in treatment of acute organophosphorus pesticide poisoning(AOPP)and its effects on cholinesterase(ChE)activity and levels of C-reactive protein(CRP),white blood cell count(WBC)and neutrophil percentage(NEUT).Methods Seventy patients with severe AOPP who were treated in the Fuyang People's Hospital were prospectively selected between November 2019 and September 2022,and they were divided into control group and observation group according to the random number table method,with 35 patients in each group.The control group was given gastric lavage,catharsis,application of antidote and other conventional treatments,while the observation group adopted resin hemoperfusion on the basis of the control group.The treatment condition,ChE activity recovery time and its level change,inflammatory indicators and accurrence of complications were compared between the two groups.Results The coma time and hospital stays of the observation group patients were(3.21±1.08)hours and 7 days,respectively,which were lower than those of the control group[(3.87±1.15)hours and 10 days],the cure rate was 97.14%,which was higher than that of the control group(82.86%),and the differences were statistically significant(P<0.05).The ChE levels of the two groups at 1 d,3 d and 5 d after treatment were higher than those before treatment,and the level showed a gradually increasing trend(P<0.05),the levels of ChE at 1 d,3 d and 5 d after treatment in observation group were(672.43±93.28),(1416.59±150.32),(3214.28±193.16)U/L,which were higher than those in control group[(629.26±106.41),(1148.65±141.57),(3095.47±185.62)U/L],and the recovery time of ChE activity was(6.08±1.01)d,which was shorter than that in control group[(6.85±1.23)d],and the differences were statistically significant(P<0.05).Compared with before treatment,the levels of CRP,WBC and NEUT in both groups were decreased after treatment,and the levels of the above indicators were(12.73±3.02)mg/L,(11.37±3.36)×10^(9)/L,(72.05

关 键 词：胆碱酯酶类 C-反应蛋白质 白细胞计数 有机磷农药中毒 树脂血液灌流 中性粒细胞百分比 

分 类 号：R595.4[医药卫生—内科学]