连续性静脉-静脉血液滤过联合血液灌流治疗急性重度有机磷中毒的临床观察  

Clinical Observation of Continuous Veno-Venous Hemofiltration Combined with Hemoperfusion in The Treatment of Severe Acute Organophosphorus Poisoning

作　　者：漆小莉 熊明分 陶宁[1] 胡建平[1] 黄柳 QI Xiaoli;XIONG Mingfen;TAO Ning(Suining Central Hospital,Sichuan Suining 629000,China)

机构地区：[1]四川省遂宁市中心医院急诊科,四川遂宁629000

出　　处：《河北医学》2024年第2期281-286,共6页Hebei Medicine

基　　金：四川省基层卫生事业发展研究中心立项项目,(编号:SWFZ17-Y-39)。

摘　　要：目的:观察连续性静脉-静脉血液滤过(CVVH)联合血液灌流(HP)治疗重度有机磷中毒(ASOPP)的临床疗效。方法:回顾性分析126例ASOPP患者资料,根据治疗方式分为CVVH+HP组(n=60)和HP组(n=66)。观察疗效和治疗情况,记录患者治疗前(T1)及治疗后4h(T2)、24h(T3)、72h(T4)时血清胆碱酯酶(CHE)水平,比较两组T1、T3时血清炎症因子[白介素-1β(IL-1β)、白介素-6(IL-6)、白介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)]以及对肝肾损伤相关指标[胱抑素(CysC)、前白蛋白(PA)、高迁移率族蛋白B1(HMGB1)]水平差值,观察并发症发生情况。结果:CVVH+HP组痊愈率为93.33%,高于HP组的78.79%(P<0.05);两组反跳发生率差异无统计学意义(P>0.05)。CVVH+HP组阿托品、氯解磷定用量分别为(143.37±18.72)mg、(10.28±2.62)g,少于HP组的(154.18±21.47)mg、(19.57±4.31)(均P<0.05);CVVH+HP组昏迷时间、住院时间分别为(13.38±3.41)h、(7.26±1.58)d,短于HP组的(22.15±4.14)h、(8.42±1.74)d(均P<0.05)。T2~T4时,两组血清CHE水平逐渐升高,且CVVH+HP组升高幅度大于HP组(均P<0.05)。T1时,两组血清IL-1β、IL-6、IL-10、TNF-α水平和血清CysC、PA、HMGB1水平差异无统计学意义(P>0.05);CVVH+HP组血清IL-1β、IL-6、IL-10、TNF-α、CysC、PA、HMGB1的T1-T3差值大于HP组(均P<0.05)。两组并发症发生情况差异无统计学意义(P>0.05)。结论:相较于HP单用,CVVH+HP治疗ASOPP可提升治愈率,改善治疗情况,促进血清CHE活性恢复,减轻炎症反应,缓解脏器损伤,且安全性良好,有一定优势。Objective:To observe the clinical efficacy of continuous veno-venous hemofiltration(CVVH)combined with hemoperfusion(HP)in the treatment of severe acute organophosphorus poisoning(ASOPP).Methods:The data of 126 patients with ASOPP were retrospectively analyzed.According to the treatment methods,the patients were divided into CVVH+HP group(n=60)and HP group(n=66).The efficacy and treatment were observed.Serum cholinesterase(CHE)level was recorded before treatment(T1)and at 4h(T2),24h(T3)and 72h(T4)after treatment.The differences of serum inflammatory factors[interleukin-1β(IL-1β),interleukin-6(IL-6),interleukin-10(IL-10),tumor necrosis factor-α(TNF-α)]and liver-kidney injury related indicators[cystatin C(CysC),prealbumin(PA),high mobility group protein B1(HMGB1)]were compared between the two groups at T1 and T3,and the occurrence of complications was observed.Results:The cure rate was 93.33%in CVVH+HP group,which was higher than 78.79%in HP group(P<0.05).There was no statistical significance in the incidence rate of rebound between the two groups(P>0.05).The dosages of atropine and pralidoxime chloride with(143.37±18.72)mg and(10.28±2.62)g in CVVH+HP group were less than(154.18±21.47)mg and(19.57±4.31)g in HP group(all P<0.05).The coma time and hospital stay in CVVH+HP group were(13.38±3.41)h and(7.26±1.58)d,which were shorter than(22.15±4.14)h and(8.42±1.74)d in HP group(all P<0.05).At T2~T4,the level of serum CHE in the two groups was increased gradually,and the increase in CVVH+HP group was greater than that in HP group(all P<0.05).At T1,the levels of serum IL-1β,IL-6,IL-10 and TNF-αand serum CysC,PA and HMGB1 revealed no statistical differences between the two groups(P>0.05).The differences of serum IL-1β,IL-6,IL-10,TNF-α,CysC,PA and HMGB1 at T1-T3 were greater in CVVH+HP group than those in HP group(all P<0.05).There was no statistical difference in the occurrence of complications between the two groups(P>0.05).Conclusion:Compared with HP alone,CVVH+HP for ASOPP can enhance the cure rate,impro

关 键 词：有机磷中毒 重度 血液灌流 连续性静脉-静脉血液滤过 

分 类 号：R595.4[医药卫生—内科学]