连续性静脉-静脉血液滤过联合还原型谷胱甘肽治疗对急性有机磷中毒患者血清胆碱酯酶水平的影响  

The effect of continuous veno-venous hemofiltration blood flow filtration combined with reduced glutathione treatment on serum cholinesterase levels in patients with acute organophosphate poisoning

作　　者：丁中喜 孙茹茹 曹虎男 陈义忠 DING Zhongxi;SUN Ruru;CAO Hunan;CHEN Yizhong(Department of Emergency Medicine,The First People's Hospital of Suqian,Suqian Jiangsu 223800,China)

机构地区：[1]宿迁市第一人民医院急诊医学科,江苏宿迁223800

出　　处：《中国急救复苏与灾害医学杂志》2025年第2期217-220,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：江苏省卫生健康委医学科研项目(编号:N2020178);2023年宿迁市第一人民医院科研专项项目(编号:KY202307)。

摘　　要：目的探讨连续性静脉-静脉血液滤过(CVVH)联合还原型谷胱甘肽(GSH)治疗对急性有机磷中毒患者血清胆碱酯酶(ChE)水平的影响。方法选择2019年1月—2023年12月宿迁市第一人民医院急诊医学中心收治的急性有机磷中毒患者60例,随机分为治疗组和对照组,各30例。两组患者均给予洗胃、补液及催吐等常规治疗。同时,治疗组接受CVVH联合GSH治疗,对照组接受CVVH治疗。对两组患者入院时、中毒1、3、7 d的ChE水平、临床观察指标(昏迷复醒时间、中毒症状消失时间、机械通气时间、住院时间)、血清心肌酶谱指标[血清肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、天氡氨酸转氨酶(AST)的水平]、氧化应激指标[氧化脂质(LPO)、丙二醛(MDA)、超氧化物歧化酶(SOD)、氧磷酯酶1(PON1)]、肾功能[血尿素氮(BUN)、尿蛋白(PRO)、血肌酐(Scr)水平]及并发症发生率进行对比分析。结果治疗组患者在治疗后1、3、7天的血清ChE水平显著高于对照组(P<0.05);治疗组在昏迷复醒时间、中毒症状消失时间、机械通气时间、住院时间上均显著低于对照组(P<0.05);治疗组在7 d后的心肌酶谱指标(CK、CK-MB、LDH、AST)均显著低于对照组,尤其是CK和AST的改善更显著(P<0.05);在氧化应激方面,治疗组在7 d后的MDA和LPO水平低于对照组,而SOD和PON1水平高于对照组,表明治疗组在氧化应激状态的改善上更为显著(P<0.05);治疗组在7 d后血清肌酐、血尿素氮、尿蛋白也显示出显著的改善(P<0.05);两组患者的不良反应发生率相似,包括中毒性心肌炎、神经受损、肝脏衰竭等,并无显著性差异(P>0.05)。结论CVVH联合GSH治疗可以有效提升急性有机磷中毒患者的血清ChE水平,改善临床症状。Objective This study aims to investigate the effect of continuous veno-venous hemofiltration(CVVH)combined with reduced glutathione(GSH)treatment on serum cholinesterase(ChE)levels in patients with acute organophosphate poisoning.Methods Sixty patients with acute organophosphorus poisoning admitted to the Emergency Medical Center of the First People's Hospital of Suqian City from January 2019 to December 2023 were randomly divided into a treatment group and a control group,with 30 cases in each group.Both groups of patients were given routine treatments such as gastric lavage,fluid replacement,and emesis induction.At the same time,the treatment group received CVVH combined with GSH treatment,while the control group received CVVH treatment.ChE levels and clinical observation indicators(coma recovery time,disappearance time of poisoning symptoms,mechanical ventilation time,hospital stay)were measured for two groups of patients at admission,1 day,3 days and 7 days after poisoning Serum myocardial enzyme spectrum indicators[CK,CK-MB,LDH,and AST]Comparative analysis was conducted on oxidative stress indicators[LPO,MDA,SOD,PON1],renal function[BUN,PRO,Scr levels],and incidence of complications.Results The serum cholinesterase(ChE)levels of patients in the treatment group were significantly higher than those in the control group on the 1 day,3 days and 7 days after treatment(P<0.05);the treatment group showed significantly lower recovery time from coma,disappearance time of toxic symptoms,mechanical ventilation time,and hospitalization time compared to the control group(P<0.05).After 7 days,the myocardial enzyme spectrum indicators(CK,CK-MB,LDH,AST)of the treatment group were significantly lower than those of the control group,especially the improvement of CK and AST was more significant(P<0.05).In terms of oxidative stress,the MDA and LPO levels in the treatment group were lower than those in the control group after 7 days,while the SOD and PON1 levels were higher,indicating that the treatment group had a more signific

关 键 词：连续性静脉-静脉血液滤过 还原型谷胱甘肽 急性有机磷中毒 血清胆碱酯酶水平 肾功能 

分 类 号：R595.6[医药卫生—内科学]