还原型谷胱甘肽联合硫酸镁在重度有机磷中毒患者治疗中的疗效观察  

Effect of combined reduced glutathione and magnesium sulfate in the treatment of patients with severe organophosphorus poisoning

作　　者：严专 顾立志 高素敏 赵红梅[1] 孙虹[1] YAN Zhuan;GU Lizhi;GAO Sumin;ZHAO Hongmei;SUN Hong(Emergency Department,Huai'an First Hospital Affiliated to Nanjing Medical University,Huai'an Jiangsu 223300,China)

机构地区：[1]南京医科大学附属淮安第一医院急诊科,江苏淮安223300

出　　处：《中国急救复苏与灾害医学杂志》2025年第3期370-374,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：中国博士后科学基金第67批面上资助二等(2020M671387)。

摘　　要：目的探讨还原型谷胱甘肽(GSH)联合硫酸镁(MgSO_(4))在重度有机磷中毒患者治疗中的疗效。方法回顾性分析于2018年7月—2022年7月在淮安市第一人民医院急诊科治疗的重度急性有机磷农药中毒患者82例,随机抽取2018年7月—2020年4月期间39例患者为对照组,抽取2021年5月—2022年7月期间43例患者为研究组,所有患者均接受常规治疗,包括初始复苏,维持呼吸道通畅、稳定循环、脏器保护、洗胃和血液净化等,研究组另外在250 mL生理盐水中加入2.4 g GSH使其完全溶解,通过静脉滴注的方式治疗,每日1次,持续7 d,并且在第1天静脉滴注4 g MgSO_(4)。比较对照组和研究组之间所需的盐酸戊乙奎醚及解磷定的总剂量,并比较两组患者的重症病房住院时间、机械通气时间、乙酰胆碱酯酶活性、转氨酶及肌酐的数值、中间综合征的发生率,以及两组之间的死亡率比较。结果对39例对照组患者和43例研究组患者的数据进行了最终分析,两组间基线参数具有可比性。与对照组相比,研究组使用的盐酸戊乙奎醚及解磷定总量较低(t=3.762、12.653,P<0.05);在EICU住院时长、机械通气时长方面,研究组的时间低于对照组(t=2.217、2.311,P<0.05);治疗后,研究组的MDA水平较对照组降低(t=3.141,P<0.05);研究组的肝肾功能及胆碱酯酶活性的恢复水平与对照组比较差异均有统计学意义(t=15.071、16.320、7.638、26.640、3.122,P<0.05);但是,在并发症发生率及临床预后方面无明显差异(P>0.05)。结论GSH和MgSO_(4)联合作为标准治疗急性有机磷中毒的辅助治疗,能降低治疗过程中的盐酸戊乙奎醚及解磷定的用量,减少患者机械通气时间以及在重症病房的住院时间,并且对于胆碱酯酶活性的恢复及肝肾功能的保护方面有效,但是对于重度急性有机磷中毒患者的并发症发生率及临床预后方面无明显改善。Objective To investigate the efficacy of reduced glutathione(GSH)combined with magnesium sulfate(MgSO_(4))in the treatment of patients with severe organophosphorus poisoning.Methods Aretrospective analysis of 82 patients withsevere AOPP who were admitted to emergency department of Huai'an First People's Hospital from July 2018 to July 2022 was conducted on this study.39 patientstreatedfrom July 2018 to April 2020 were selected as the control group;and 43 patients treated from May 2021 to July 2022 were selected as the study group.All patients received routine treatment,including initial resuscitation,maintaining respiratory patency,stable circulation,organ protection,gastric lavage,and blood purification.MgSO_(4) combined with RGH treatments were given to the patients of the study group.The total dose of pentylethyl hydrochloride injection required;differences in hospitalization time,mechanical ventilation time,acetylcholinesterase activity,transaminase values,incidence of intermediate syndrome,and mortality rate were compared and analyzed between the two groups.Results There wasstatistically significant in the total amounts of pentylethoxyquine hydrochloride and dephosphorization between the two groups(t=3.762,12.653,P<0.05).The hospitalization time and mechanical ventilation time of the study group were shorter than those of the control group,with a statistically significant difference(t=2.217,2.311,P<0.05).The MDA levels decreased significantly after treatments between the two groups(t=3.141,P<0.05).Compared with the control group,the recovery levels of liver and kidney function and cholinesterase activity in the study group were significantly difference(t=15.071,16.320,7.638,26.640,3.122,P<0.05);however,there was no statistically significant difference in the incidence of complications and clinical prognosis between the two groups(P>0.05).Conclusion RGH combined with MgSO_(4) treatment has a better therapeutic effect on patients with severe AOPP.However,no significant improvement in the incidence of complicat

关 键 词：还原型谷胱甘肽 硫酸镁 有机磷中毒 

分 类 号：R595.4[医药卫生—内科学]