阿托品联合连续静脉-静脉血液滤过及血液灌流治疗老年急性重症有机磷中毒的临床分析  

Clinical analysis of atropine combined with continuous veno-venous hemofiltration and hemoperfusion in the treatment of acute severe organophosphate poisoning in the elderly

作　　者：刘跃辉[1] 宋俊坤 郝炎[1] 宋宗辉 Liu Yuehui;Song Junkun;Hao Yan;Song Zonghui(Department of Pharmacy,First People’s Hospital of Zigong City,Zigong,Sichuan,643000,P.R.China)

机构地区：[1]自贡市第一人民医院药剂科,四川自贡643000

出　　处：《老年医学与保健》2024年第1期195-200,210,共7页Geriatrics & Health Care

摘　　要：目的分析老年急性重症有机磷中毒患者接受阿托品联合连续静脉-静脉血液滤过(CVVH)+血液灌流(HP)治疗方案的疗效。方法回顾性选取2019年1月—2022年1月于自贡市第一人民医院救治的老年急性重症有机磷中毒患者64例,根据不同救治方案将患者分为使用阿托品救治的对照组(32例)和使用阿托品联合CVVH+HP方案救治的观察组(32例)。2组均接受反复清洗胃部、甘露醇或硫酸镁导泻、大量吸氧、平衡电解质、应用胆碱酯酶复能剂氯磷定等常规急救措施,此外,对照组使用阿托品救治,观察组使用阿托品联合CVVH+HP方案救治。观察并比较2组恢复情况、胆碱酯酶(ChE)水平、心肝肾等脏器功能损伤程度评估值[心功能指标值:心肌肌钙蛋白I(cTnI)、心肌肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB);肝功能指标值:丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST);肾功能指标值:尿蛋白定量、尿素氮、血肌酐)];评估并比较2组机体氧化应激程度[人过氧化脂质(LPO)、丙二醛(MDA)、超氧化物歧化酶(SOD)水平]、局部炎症情况[白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、降钙素原(PCT)水平]、不良事件、临床疗效以及缓解期严重并发症发生情况。结果与对照组比较,观察组患者清醒时间、机械通气时间、ChE活性恢复正常时间和住院时间均明显缩短,差异均有统计学意义(P<0.05)。治疗后,2组ChE水平均高于同组治疗前,且观察组ChE水平高于对照组,差异均有统计学意义(P<0.05)。治疗后,2组患者CK-MB、cTnI、cTnT、ALT、AST、尿蛋白定量、尿素氮、血肌酐水平均低于同组治疗前,观察组均低于对照组,差异均有统计学意义(P<0.05)。治疗后,2组患者LPO和MDA水平均低于同组治疗前,而SOD水平高于同组治疗前;观察组LPO和MDA水平均低于对照组,而SOD水平高于对照组,差异均有统计学意义(P<0.05)。治疗后,2组患者IL-1β、IL-6、PCTObjective To analyze the effects of atropine combined with continuous veno-venous hemofiltration(CVVH)and hemoperfusion(HP)in the treatment of acute severe organophosphate poisoning in the elderly.Methods 64 elderly patients with acute severe organophosphorus poisoning treated in First People s Hospital of Zigong City from January 2019 to January 2022 were retrospectively selected.According to different treatment plans,they were divided into control group(32 cases,treated with atropine)and observation group(32 cases,treated with atropine combined with CVVH+HP regimen).Both groups received routine first aid measures such as repeated cleaning of the stomach,induction of diarrhea with mannitol or magnesium sulfate,extensive oxygen inhalation,electrolyte balance,and use of cholinesterase(ChE)reactivator pralidoxime chloride.In addition,the control group was treated with atropine,and the observation group was treated with atropine combined CVVH+HP.The recovery condition,the ChE level,and the evaluation values of the degree of cardiac,liver and kidney function injury[cardiac function indexes:cardiac troponin I(cTnI),cardiac troponin T(cTnT),creatine kinase isoenzyme(CK-MB);liver function indexes:alanine aminotransferase(ALT),aspartate aminotransferase(AST);renal function indexes:urinary protein quantification,urea nitrogen,blood creatinine)]of the two groups were observed and compared.The degree of oxidative stress[the levels of human lipid peroxide(LPO),malondialdehyde(MDA),superoxide dismutase(SOD)],local inflammation[the levels of interleukin-1β(IL-1β),interleukin-6(IL-6),procalcitonin(PCT)],as well as adverse events,clinical efficacy and incidence of severe complications during remission of the two groups were observed and compared.Results Compared with the control group,the awake time,mechanical ventilation time,ChE activity recovery time and hospitalization time of the observation group were significantly shortened(P<0.05).After treatment,the ChE level of the two groups was higher than that of the same group be

关 键 词：老年 急性重症有机磷中毒 阿托品 连续静脉—静脉血液滤过 血液灌流 

分 类 号：R595.4[医药卫生—内科学]