不同血液净化方式对急性重度有机磷农药中毒疗效的研究

发布时间：2018-06-20 11:37

本文选题：血液净化 + 急性重度有机磷农药中毒　；参考：《第四军医大学》2016年硕士论文

【摘要】：目的有机磷农药在我国应用广泛,是常见的中毒原因。传统治疗对轻中度有机磷农药中毒可取得理想疗效,但是对重度有机磷农药中毒治疗效果不佳。近年来,血液净化越来越多的应用于重度有机磷农药中毒,为临床提供了更有效的救治方式。本研究对急性重度有机磷农药中毒患者的相关临床资料进行统计分析,探讨血液灌流(hemoperfusion,HP)联合血浆置换(plasma exchange,PE)对急性重度有机磷农药中毒患者的疗效。方法回顾性分析2012年12月至2014年12月第四军医大学西京医院急诊科收治的急性重度有机磷农药中毒91例患者的资料,将患者分为常规治疗组(CT组)33例,血液灌流组(HP组)30例及血液灌流联合血浆置换组(HE组)28例,比较各组患者入院时的一般情况,并对临床疗效、血生化指标、并发症和治疗前后的血清胆碱酯酶活性和炎症因子肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-1β(interleukim-1β,IL-1β)、白细胞介素-6(interleukim-6,IL-6)、白细胞介素-8(interleukim-8,IL-8)进行统计学分析。结果各组患者入院时一般情况比较无统计学差异。HP组和HE组较CT组的治愈率升高,阿托品总用量、氯解磷定总用量减少,住院时间、昏迷时间缩短(P0.05),HE组的阿托品总用量、氯解磷定总用量、昏迷时间显著低于HP组(P0.05);HE组肌酐(cratinine,Cr)、血淀粉酶(amylase,AMY)较CT组、HP组显著下降,HE组谷丙转氨酶(alanine amino transferase,ALT)较CT组显著下降(P0.05),与HP组比较无统计学差异;HP组、HE组的胆碱酯酶活性在治疗后4h、24h、72h均显著高于CT组(P0.05),HE组的胆碱酯酶活性在治疗后24h显著高于HP组(P0.05);HP组和HE组并发症较CT组明显减少(P0.05);HE组炎症因子在治疗后显著低于HP组和CT组(P0.05)。结论HP对急性重度有机磷农药中毒有着显著疗效,HP联合PE可进一步提高临床效果,改善患者的肝肾、胰腺功能,快速升高患者的胆碱酯酶活性,减少患者的并发症,潜在机制可能与降低患者的炎症因子有关。但是PE治疗费用较高,在基层医院开展存在着一定困难。
[Abstract]:Objective organophosphorus pesticide is widely used in China and is a common cause of poisoning. The effect of traditional treatment on mild and moderate organophosphorus pesticide poisoning is ideal, but it is not good for severe organophosphorus pesticide poisoning. In recent years, blood purification is more and more used in severe organophosphorus pesticide poisoning, which provides a more effective treatment for clinical treatment. In this study, the clinical data of patients with acute severe organophosphorus pesticide poisoning were statistically analyzed, and the curative effect of hemoperfusion HPX combined with plasma exchange (PEP) on patients with acute severe organophosphorus pesticide poisoning was investigated. Methods the data of 91 patients with acute severe organophosphorus pesticide poisoning treated in the emergency department of Xijing Hospital of fourth military Medical University from December 2012 to December 2014 were retrospectively analyzed. The patients were divided into routine treatment group (n = 33) and CT group (n = 33). The hemoperfusion group (HP) group (n = 30) and hemoperfusion combined plasma exchange group (n = 28) with HE group (n = 28) were compared. Serum cholinesterase activity and tumor necrosis factor- 伪 (TNF- 伪), interleukim-1 尾 (IL-1 尾), interleukin-6 (IL-6) interleukim-6 (IL-6) and interleukin-8 interleukim-8IL-8 (IL-8) were analyzed before and after treatment. Results there was no significant difference in the general condition of the patients at admission. The cure rate of HP group and HE group was higher than that of CT group. The total dosage of atropine, total dosage of chlorophosphoridine, hospitalization time and coma time were decreased, and the total dosage of atropine in HE group was shortened than that in HE group. Total dosage of phosphorylchloride, The coma time was significantly lower than that in HP group (P 0.05), and the serum amylase (AMY) was significantly lower than that in HP group (P 0.05). The activity of cholinesterase in HP group was significantly lower than that in HE group (P 0.05), and the activity of cholinesterase in HP group was not significantly different from that in HP group (P < 0.05), and the activity of cholinesterase in HP group was significantly lower than that in CT group (P < 0.05), and the activity of cholinesterase in HP group was not significantly different from that in HP group (P < 0.05). The activity of cholinesterase in the HE group was significantly higher than that in the HP group at 24 h after treatment and the complications in the HP group were significantly higher than those in the HP group and the HE group. The inflammatory factors in the HE group were significantly lower than those in the HP group and the CT group after treatment, and the activity of cholinesterase in the HE group was significantly lower than that in the HP group and CT group. Conclusion HP has significant curative effect on acute severe organophosphorus pesticide poisoning. HP combined with PE can further improve the clinical effect, improve the function of liver, kidney and pancreas, increase the cholinesterase activity rapidly, and reduce the complications of the patients. The underlying mechanism may be related to the reduction of inflammatory factors in patients. However, PE treatment costs are high, there are some difficulties in the development of primary hospitals.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R595.4

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