血液灌流对重度有机磷农药中毒伴心肌损伤患者心肌酶谱和炎症指标变化的影响  

Effect of hemoperfusion on changes of myocardial enzymes and inflammatory indexes in patients with severe organophosphorus pesticide poisoning and myocardial injury

作　　者：俞春梅 王蕾[1] 陈芬芬 朱保锋[1] YU Chunmei;WANG Lei;CHEN Fenfen;ZHU Baofeng(Department of Emergency,Nantong First People's Hospital,Nantong 226300,Jiangsu,China)

机构地区：[1]南通市第一人民医院急诊科,江苏南通226300

出　　处：《西部医学》2024年第9期1371-1375,共5页Medical Journal of West China

基　　金：南通市科技项目(MS22020010)。

摘　　要：目的探讨血液灌流对重度有机磷农药中毒伴心肌损伤患者心肌酶谱和炎症指标变化的影响。方法回顾性分析本院2018年1月—2022年12月接诊的重度有机磷农药伴心肌损伤的80例患者,按照实际治疗期间是否进行血液灌流治疗分为对照组30例与观察组50例,对照组采用常规救治,观察组在对照组的基础上加以血液灌流进行治疗。对比分析两组患者治疗前后格拉斯哥昏迷指数(GCS)评分、血清胆碱酯酶(ChE)、乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、肌动蛋白(cTnⅠ)以及降钙素原(PCT)、C反应蛋白(CRP)水平以及临床疗效。根据临床疗效,将观察组分为治愈组、有效组、无效组3个亚组,比较不同疗效患者血清ChE、LDH、CK、CK-MB、cTnⅠ、PCT、CRP水平。结果治疗后,两组患者血清LDH、CK、CK-MB、cTnⅠ、PCT、CRP水平均显著低于治疗前,ChE水平以及GCS评分显著高于治疗前(P<0.05),观察组患者血清LDH、CK、CK-MB、PCT、CRP水平显著低于对照组,ChE水平显著高于对照组(P<0.05);且随着临床疗效增加,血清LDH、CK、CK-MB、cTnⅠ、PCT、CRP水平逐渐降低,ChE水平逐渐升高,两两比较差异均存在统计学意义(P<0.05)。结论血液灌流治疗重度有机磷农药中毒伴心肌损伤患者疗效显著,可显著降低心肌酶谱(LDH、CK、CK-MB、cTnⅠ)和炎症指标(PCT、CRP)水平,对心肌损伤及炎症反应具有积极影响,且疗效越显著,其血清水平下降越快。Objective To investigate the effect of hemoperfusion on the changes of myocardial enzymes and inflammatory indexes in patients with severe organophosphorus pesticide poisoning and myocardial injury.Methods We retrospectively analyzed 80 patients with severe organophosphorus pesticides with myocardial injury seen in our hospital from January 2018 to December 2022,and divided into a control group(30 patients)and an observation group(50 patients)according to whether blood perfusion treatment was performed during the actual treatment period,with the control group treated with conventional salvage treatment and the observation group treated with blood perfusion on the basis of the control group.The Glasgow Coma Index(GCS)score,serum cholinesterase(ChE),lactate dehydrogenase(LDH),creatine kinase(CK),creatine kinase isoenzyme(CK-MB),actin(cTnI.),procalcitonin(PCT)and C-reactive protein(CRP)levels and clinical efficacy were compared between the two groups before and after treatment.According to the clinical efficacy,the observation group was divided into three subgroups:cured group,effective group and ineffective group,and the serum levels of ChE,LDH,CK,CK-MB,cTnI.,PCT and CRP of patients with different efficacy were compared.Results After treatment,the serum levels of LDH,CK,CK-MB,cTnI.,PCT and CRP in both groups were significantly lower than those before treatment,ChE level and GCS score were significantly higher than before treatment(P<0.05).The serum LDH,CK,CK-MB,PCT,CRP levels in the observation group were significantly lower than those in the control group,and ChE levels were significantly higher than those in the control group(P<0.05).With the increase of clinical efficacy,serum LDH,CK,CK-MB,cTnI.,PCT,The CRP level decreased gradually and the ChE level gradually increased,and the difference between the two comparisons was statistically significant(P<0.05).Conclusion Hemoperfusion has a significant effect on the treatment of patients with severe organophosphorus pesticide poisoning and cardiac injury,which can sign

关 键 词：心肌酶谱 炎症 重度有机磷农药中毒 心肌损伤 血液灌流 

分 类 号：R595.4[医药卫生—内科学]