血液灌流在重度急性有机磷农药中毒治疗中的应用

发布时间：2018-06-17 02:50

本文选题：有机磷中毒 + 血液灌流　；参考：《浙江大学》2017年硕士论文

【摘要】：目的分析血液灌流(hemoperfusion HP)对重度急性有机磷农药重度中毒(AOPP)治疗效果方法:入选病例为2008年9月至2011年9月在我院住院的重度AOPP患者82例(剔除自行终止治疗或转院),灌流组(HP组)为入院接受了灌流治疗,非灌流组(非HP组)为入院后没有接受灌流治疗,非HP组按常规予积极洗胃,导泻,催吐,并予阿托品及解磷定治疗。HP组在上述治疗基础上同时加用HP治疗,观察全部病例的农药服用量,患者的一般情况、中毒药物类型,首诊时间,初诊时胆碱酯酶(CHE)活力,血肌酐、动脉血氧分压和病死率,急性呼吸衰竭的发生率。观察存活病例:CHE恢复时间,并评估两组病人在治疗过程中阿托品化时间、到达阿托品化时阿托品的用量、氯磷定用量、病程中阿托品的总量及中间综合征(IMs)发生率、机械通气时间、APACHEII评分、血液灌流引起的并发症,并记录全部患者的住院天数,以上数据评价HP抢救有机磷农药中毒的效果。记录HP组患者HP前后血红蛋白(HB)浓度,白细胞(WBC),血小板(PIT)数、纤维蛋白原(metaglobulin)水平来判断HP对血细胞成分和凝血系统的影响;记录HP治疗过程中第10分钟,60分钟,120分钟的平均动脉压和其他不良反应。以住院死亡为观察终点,观察影响患者预后的危险因素,同时观察血液灌流组患者与HP相关的并发症。结果:非HP组与HP组比较,性别、农药服用量、中毒农药类型无差异(P0.05;)。两组患者呼吸衰竭发生率、中毒到开始抢救时间、入院时胆碱酯酶活力比较差异均无统计学意义(P0.05)。与非HP组比较,HP组患者阿托品化时间[(4.54±0.9)hVS(5.24±0.8)h]、血清胆碱酯酶恢复正常时间[(9.54±1.1)d VS(11.3±1.5)d]、住院时间[(10.5±1.2)d VS(13.44±2.1)d]均缩短,阿托品化量[(262.1±29.7)mgVS(294.8±31.6)mg]降低,差异有统计学意义(P0.05)。中间综合征发生率[12.2%(5/41)VS19.5%(8/41)]、机械通气时间[(4.06±0.68)dVS(5.01±0.60)d]、阿托品总量[(801.9±91.4)mg VS(974.4±87.3)mg]明显降低(P0.01),两组之间氯磷定用量HP组(17.89±5.98)VS非HP组(21.75±6.22)差异有统计学意义(P0.05)。死亡危险因素分析:死亡组VS存活组在年龄(58.6±17.3)VS(42.8±12.5)、农药服用量(188.7±28)VS(78.9±32.7)、初始胆碱酯酶活力(235±55.4)VS(809.2±588.9)、并发症、APACHEII评分(18.8±9.9)VS(7.9±6.3)与患者的预后密切相关(P0.01),HP可能影响预后。HP前后HB浓度无显著变化(P0.05)。HP对血压、白细胞(14.7±5.1)VS(12.6±4.8)、血小板(208±43.9)VS(179±55.4)、纤维蛋白原(2.85±1.15)VS(3.38± 1.26)有影响(P0.05)。结论:1.HP能减少阿托品用量、缩短阿托品化时间、缩短胆碱酯酶恢复时间、缩短住院时间。2.HP可明显减少AOPP患者IMS的发生率,缩短机械通气时间。3.HP对血压及血液部份成份有少许影响,但不影响治疗。
[Abstract]:Objective to analyze the therapeutic effect of hemoperfusion HPP on severe acute organophosphorus pesticide poisoning (AOPP). 82 patients with severe AOPP who were hospitalized in our hospital from September 2008 to September 2011 were selected. The hospital, the perfusion group (HP group) was admitted to the hospital to receive perfusion treatment, The non-perfusion group (non-HP group) did not receive perfusion therapy after admission, and the non-HP group was treated with active gastric lavage, catharsis, emesis, atropine and alophosphamide treatment. The HP group was treated with HP on the basis of the above mentioned treatment at the same time. The dosage of pesticide, the general condition of the patients, the type of poisoning drugs, the time of first visit, the activity of cholinesterase (che), the blood creatinine, the partial pressure of oxygen in arterial blood, the death rate and the incidence of acute respiratory failure were observed. To observe the recovery time of surviving case: che, and to evaluate the time of atropinization during treatment, the dosage of atropine, the dosage of chlorophosphoridine, the total amount of atropine during the course of the disease and the incidence of intermediate syndrome (IMs). The mechanical ventilation time, Apache II score, complications caused by hemoperfusion, and the days of hospitalization of all patients were recorded. The above data were used to evaluate the efficacy of HP in rescuing organophosphorus pesticide poisoning. In HP group, the concentration of HB and HBs, the number of WBCU, the number of platelet PITs and the level of fibrinogen were recorded to determine the effect of HP on blood cell composition and coagulation system. The mean arterial pressure and other adverse reactions were recorded at 10 min, 60 min and 120 min during HP treatment. The end point of inpatient death was observed to observe the risk factors affecting the prognosis of the patients and the HP related complications in the hemoperfusion group were observed. Results: there was no difference in sex, dosage of pesticide and type of toxic pesticide between non HP group and HP group (P 0. 05). The incidence of respiratory failure, the time from poisoning to the beginning of rescue, and the difference of cholinesterase activity between the two groups were not statistically significant (P 0.05). Compared with the non-HP group, the atropinization time [4.54 卤0.9hVSU 5.24 卤0.8h], the serum cholinesterase recovery time [9.54 卤1.1 days vs 11.3 卤1.5 days], the hospitalization time [10.5 卤1.2 days vs 13.44 卤2.1 days] and the atropine volume (262.1 卤29.7mgVS294.8 卤31.6)mg) were significantly decreased. The incidence of intermediate syndrome [12.2v / 41VS19.5V = 8 / 41], mechanical ventilation time (4.06 卤0.68dVS5.01 卤0.60g / d), total atropine [801.9 卤91.4)mg VSN 974.4 卤87.3)mg] significantly decreased P0.01.The difference between the two groups was significant (P 0.05). There was a significant difference between the HP group and the HP group (17.89 卤5.98 vs + 21.75 卤6.22). Analysis of the risk factors of death: the age of vs survival group was 58.6 卤17.3VSN 42.8 卤12.5m, the dosage of pesticide was 188.7 卤28VSN 78.9 卤32.7m, the initial cholinesterase activity was 235 卤55.4VSn 809.2 卤588.9, the Apache II score was 18.8 卤9.9VSv 7.9 卤6.3) and the prognosis of patients was closely related to the prognosis (P0.01P). There was no significant change in HB concentration before and after HP (P 0.05.HP). WBC: 14.7 卤5.1VSN 12.6 卤4.8m, platelets 208 卤43.9VSN 179 卤55.4U, fibrinogen 2.85 卤1.15VSN 3.38 卤1.26). Conclusion: 1. HP can reduce the dosage of atropine, shorten the time of atropinization, shorten the time of cholinesterase recovery, and shorten the hospitalization time. 2. HP can obviously reduce the incidence of IMS in AOPP patients. Shortening mechanical ventilation time. 3. HP has a little effect on blood pressure and blood components, but does not affect treatment.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R595.4

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