观察不同血液灌流模式联合持续肾脏替代治疗在治疗急性有机磷农药中毒患者中的临床疗效

发布时间：2018-04-08 18:32

  本文选题：急性重度有机磷中毒　切入点：血液灌流　出处：《青岛大学》2017年硕士论文

【摘要】：目的:观察不同血液灌流(hemoperfusion,HP)模式联合持续肾脏替代治疗(continuous renal replacement therapy,CRRT)在治疗急性重度有机磷农药中毒(acute severe organophosphorus pesticide poisoning,ASOPP)患者中的临床疗效。方法:选取2014年12月至2017年02月期间在泰山医学院附属青州医院收治的63例ASOPP患者为研究对象,随机分为加强组(30例)和常规组(33例),两组患者入院后均立即给予一般治疗,包括洗胃、应用常规药物,均在一般治疗的基础上采用不同模式的HP+CRRT治疗。根据患者意识情况和血气分析情况,决定是否给于经口气管插管应用呼吸机辅助呼吸,出现呼吸、心跳骤停病人,即刻行心肺复苏术。常规组应用HP每天1次,每次2h,连续3 d。加强组应用HP第1天每8h进行1次,每次2h,第2天每12h进行1次,每次2h,第3天只进行1次,持续2h。采用SPSS 19.0软件包进行统计学分析,计量资料数据以x±s表示,组间比较采用t检验,治疗不同时期胆碱酯酶活力数据分析采用重复测量方差分析,计数数据采用X2检验,以P0.05为有显著性。比较两组患者的一般情况、中毒至治疗开始时间、治疗前APACHEII评分、常规药物用量,生化指标、胆碱酯酶活力、出现呼吸衰竭例数、通气时间、住院天数、出现并发症情况和死亡率等。并对死亡患者和存活患者服毒剂量、APACHEII评分、中毒至治疗时间、胆碱酯酶活力进行比较,初步分析患者死亡的影响因素。结果:两组患者在性别、年龄、中毒药物、中毒量和中毒至抢救时间方面差异均无统计学意义(P0.05),具有可比性。加强组患者常规药物的用量均显著小于常规组(P0.05),通气时间和住院时间均显著小于常规组(P0.01)。两组患者治疗前胆碱酯酶活力无统计学差异(P0.05),加强组治疗3d和治疗5d的胆碱酯酶活力显著高于常规组(P0.01)。加强组患者除呼吸衰竭外并发症发生率、死亡率均显著低于常规组(P0.05)。死亡患者服毒剂量、APACHEII评分、中毒致洗胃时间死亡患者显著高于存活患者(P0.05)。结论:加强HP+CRRT模式治疗ASOPP患者,有利于减少常规药物用量,缩短通气时间和住院时间,加快胆碱酯酶活力恢复速度,减少并发症,降低病死率。服毒剂量、APACHEⅡ评分、救治时间、胆碱酯酶活力可能是患者死亡的影响因素,治疗时应给予重视。意义:血液净化目前是治疗中毒患者的一种有效措施,在治疗ASOPP患者中HP+CRRT的次数对最终的临床结局的影响研究很少,日常临床工作中多数以经验性治疗为主,本研究结果显示加强HP+CRRT模式是一种安全、有效的治疗方案,且简便易行,值得基层医院推广应用。
[Abstract]:Methods: from December 2014 to February 2017, 63 patients with ASOPP in Qingzhou Hospital affiliated to Taishan Medical College were randomly divided into two groups: strengthening group (n = 30) and routine group (n = 33). The patients in both groups were given general treatment immediately after admission.Both gastric lavage and routine drugs were treated with HP CRRT on the basis of general treatment.According to the patient's consciousness and blood gas analysis, it was decided whether to apply ventilator to the tracheal intubation, breathing, cardiac arrest, cardiopulmonary resuscitation.The routine group was treated with HP once a day for 2 hours for 3 days.In the strengthening group, HP was given once every 8 hours on the first day, once every 12 hours on the second day, and only once every 2 hours on the third day for 2 hours.The statistical analysis was carried out by SPSS 19.0 software package. The measurement data were expressed as x 卤s. T test was used to compare the cholinesterase activity among groups, the repeated measurement analysis of variance was used to analyze the cholinesterase activity data in different treatment periods, and the X2 test was used to count the data.In order to P0.05 as significant.The general condition of the two groups, the time of poisoning to the beginning of treatment, the APACHEII score before treatment, the dosage of routine drugs, biochemical indexes, cholinesterase activity, the number of cases of respiratory failure, the time of ventilation, the days of hospitalization, the general condition of the two groups were compared.Complications and mortality.The APACHEII score, time from poisoning to treatment, cholinesterase activity were compared between the dead patients and the surviving patients, and the influencing factors of the patients' death were analyzed.Results: there was no significant difference between the two groups in sex, age, poisoning drug, poisoning amount and time from poisoning to rescue.The dosage of routine drugs in the strengthening group was significantly lower than that in the routine group, and the ventilation time and hospitalization time were significantly lower than that in the routine group.There was no significant difference in cholinesterase activity between the two groups before treatment. The cholinesterase activity in the strengthening group was significantly higher than that in the control group on the 3rd day and 5th day.The incidence of complications and mortality in the strengthening group were significantly lower than those in the routine group except respiratory failure (P 0.05).APACHEII score was significantly higher in the dead patients than in the surviving patients (P 0.05).Conclusion: the enhancement of HP CRRT model in the treatment of ASOPP patients is beneficial to reduce the dosage of conventional drugs, shorten the time of ventilation and hospitalization, accelerate the recovery of cholinesterase activity, reduce complications and reduce the mortality.APACHE 鈪，

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