血液灌流治疗在急性重度有机磷中毒患者抢救中的应用效果  

Application Effect of Hemoperfusion Therapy in Rescue of Acute Severe Organophosphorus Poisoning Patients

作　　者：吴飞[1] 邹洪其 WU Fei;ZOU Hongqi(Department of Emergency,Zhejiang Provincial People's Hospital Bijie Hospital,Bijie Guizhou 551700,China)

机构地区：[1]浙江省人民医院毕节医院急诊科,贵州毕节551700

出　　处：《中国卫生标准管理》2024年第12期121-124,共4页China Health Standard Management

摘　　要：目的探讨血液灌流(hemoperfusion,HP)治疗对急性重度有机磷中毒(acute severe organophosphorus poisoning,ASOPP)患者抢救结果及病情恢复时间的影响。方法回顾性分析2021年9月—2023年5月浙江省人民医院毕节医院收治的82例ASOPP患者临床资料,依据治疗方法将患者分为2组,各41例。对照组采用硫酸阿托品注射液联合碘解磷定注射液治疗,观察组在对照组基础上加用HP治疗,2组均连续治疗3 d。对比2组抢救结果、病情恢复时间[意识恢复时间、脱机时间、血清胆碱酯酶(acetylcholinesterase,ACHE)活性恢复时间]、肝肾功能[天冬氨酸转氨酶(glutamic oxaloacetic transaminase,AST)、丙氨酸转氨酶(glutamic pyruvic transaminase,ALT)、血肌酐(serum creatinine,Scr)和尿氮素水平(blood urea nitrogen,BUN)]、神经功能[腓总神经运动传导速度(motor nerve conduction velocity,MCV)、感觉传导速度(sensory nerve conduction velocity,SCV)和F波潜伏期]和并发症(呼吸急促、心律失常、血液病变、低血压)。结果观察组抢救成功率为97.56%,高于对照组的80.49%,差异有统计学意义(P<0.05);观察组患者意识恢复时间为(3.54±1.28)h,脱机时间为(2.72±0.91)d,ACHE活性恢复时间为(4.15±1.12)d,短于对照组的(9.38±1.53)h、(7.09±1.45)d、(6.72±1.69)d,差异有统计学意义(P<0.05);治疗后,观察组AST为(26.13±5.15)U/L,ALT为(25.04±7.62)U/L,Scr为(110.69±20.15)μmol/L,BUN为(7.25±0.58)mmol/L,均低于对照组的(35.16±8.65)U/L、(40.76±10.28)U/L、(174.56±26.47)μmol/L、(9.62±1.08)mmol/L,差异有统计学意义(P<0.05);治疗后,观察组MCV为(48.26±8.32)m/s,SCV为(46.37±8.02)m/s,均高于对照组的(40.06±6.12)m/s、(39.54±6.35)m/s;F波潜伏期为(21.89±2.42)ms,低于对照组的(26.56±3.17)ms,差异有统计学意义(P<0.05);观察组的并发症总发生率为9.09%(3/33),和对照组的15.00%(6/40)比较,差异无统计学意义(P>0.05)。结论应用HP治疗ASOPP患者可提高抢救成功率,缩短病情恢Objective To investigate the effect of hemoperfusion(HP)treatment on the rescue results and recovery time in patients with acute severe organophosphorus poisoning(ASOPP).Methods The clinical data of 82 ASOPP patients admitted to Zhejiang Provincial People's Hospital Bijie Hospital from September 2021 to May 2023 were reviewed,and the patients were divided into two groups according to treatment methods,41 each.The control group was treated with atropine sulfate injection combined with iodine lysis and phosphate injection,and the observation group was treated with HP in the control group,and both groups were treated continuously for 3 d.The rescue results,recovery time[consciousness recovery time,weaning time,and acetylcholinesterase(ACHE)activity recovery time],liver and kidney function[glutamic oxaloacetic transaminase(AST),glutamic pyruvic transaminase(ALT),serum creatinine(Scr)and blood urea nitrogen(BUN)],nerve function[motor nerve conduction velocity(MCV),sensory nerve conduction velocity(SCV)and F-wave latency]and complications(tachypnea,arrhythmia,hematological lesions,hypotension)were compared.Results The success rate of rescue in the observation group was 97.56%,higher than that in the control group(80.49%),the difference was statistically significant(P<0.05).The recovery time of consciousness in observation group was(3.54±1.28)h,the offline time was(2.72±0.91)d,and the recovery time of ACHE activity was(4.15±1.12)d,which was shorter than that of control group(9.38±1.53)h,(7.09±1.45)d,(6.72±1.69)d,the difference was statistically significant(P<0.05).After treatment,the AST,ALT,Scr and BUN of the observation group were(26.13±5.15)U/L,(25.04±7.62)U/L,(110.69±20.15)μmol/L and(7.25±0.58)mmol/L respectively,which was lower than that of control group(35.16±8.65)U/L,(40.76±10.28)U/L,(174.56±26.47)μmol/L,(9.62±1.08)mmol/L,the difference was statistically significant(P<0.05).After treatment,MCV and SCV in observation group were(48.26±8.32)m/s and(46.37±8.02)m/s,both higher than those in control g

关 键 词：急性重度有机磷中毒 血液灌流 抢救结果 病情恢复 肝肾功能 神经功能 并发症 

分 类 号：R594[医药卫生—内科学]