血必净对有机磷中毒血液灌流患者的治疗效果及作用机制

发布时间：2018-04-15 23:02

本文选题：有机磷中毒 + 血必净　；参考：《山东医药》2017年24期

【摘要】：目的探讨血必净对有机磷中毒血液灌流患者的治疗效果及作用机制。方法选取急性有机磷中毒患者88例,随机分为观察组和对照组各44例。两组均行血液灌流治疗,观察组再静滴血必净注射液50 m L+生理盐水100 m L,1次/d。两组均连续治疗14天。比较两组苏醒时间、呼吸机使用时间、阿托品使用量。治疗前后检测胆碱酯酶活性,统计停用阿托品后胆碱酯酶活性75%者所占比例;检测血清CRP、脂联素(APN)水平,计算CRP/APN;检测外周血单个核细胞(PBMCs)Toll样受体2(TLR2)、TLR4、NF-κB mRNA相对表达量。结果两组苏醒时间、呼吸机使用时间比较差异均无统计学意义(P均0.05),观察组阿托品使用量少于对照组(P0.05)。两组停用阿托品后胆碱酯酶活性75%者所占比例比较P0.05。治疗第3、5、7天两组胆碱酯酶活性均高于治疗前,且观察组均高于对照组(P均0.05)。治疗后观察组血清CRP水平及CRP/APN均较治疗前降低,血清APN水平较治疗前升高,且观察组上述指标变化更显著(P均0.05)。治疗后观察组TLR2、TLR4、NF-κB mRNA相对表达量均较治疗前降低,且观察组均低于对照组(P均0.05)。结论血必净可减少有机磷中毒血液灌流患者阿托品使用量,提高胆碱酯酶活性;抑制TLRs/NF-κB信号通路、减少炎症因子分泌可能是其作用机制。
[Abstract]:Objective to investigate the therapeutic effect and mechanism of Xuebijing on hemoperfusion of organophosphorus poisoning.Methods 88 patients with acute organophosphorus poisoning were randomly divided into observation group (n = 44) and control group (n = 44).Both groups were treated with hemoperfusion, and in the observation group, 50 mL normal saline was given once a day.Both groups were treated continuously for 14 days.The recovery time, ventilator time and atropine usage were compared between the two groups.The activity of cholinesterase was measured before and after treatment, and the proportion of 75% patients with cholinesterase activity after cessation of atropine was counted, the serum CRP, adiponectin (APN) levels were measured, and the relative expression of TLR4NF- 魏 B mRNA in peripheral blood mononuclear cells (PBMCs) was detected by measuring the relative expression of TLR4NF- 魏 B mRNA in peripheral blood mononuclear cells (PBMCs).Results there was no significant difference in recovery time and ventilator use time between the two groups (P < 0.05). The usage of atropine in the observation group was less than that in the control group (P 0.05).The proportion of patients with 75% cholinesterase activity after cessation of atropine was compared between the two groups (P 0.05).The activity of cholinesterase in the two groups was higher than that before treatment on the 7th day after treatment, and the activity of cholinesterase in the observation group was higher than that in the control group (P < 0.05).After treatment, the levels of serum CRP and CRP/APN in the observation group were lower than those before treatment, and the level of serum APN was higher than that before treatment, and the changes of the above indexes in the observation group were more significant (P < 0.05).After treatment, the relative expression of NF- 魏 B mRNA in TLR2 + TLR4 was lower in the observation group than that in the control group, and was lower than that in the control group (P < 0.05).Conclusion Xuebijing can reduce the amount of atropine and increase the activity of cholinesterase in patients with organophosphorus poisoning, inhibit the signal pathway of TLRs / NF- 魏 B and decrease the secretion of inflammatory factors.
【作者单位】：复旦大学附属中山医院青浦分院;同济大学附属同济医院;
【分类号】：R595.4

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