血液灌流联合长托宁对急性有机磷中毒患者血清高敏C反应蛋白和白细胞介素-18的影响

Effects of c reactive protein and IL-18 for hemoperfusion combined penehyclidine hydrochloride in patients with acute organophosphorus poisoning

目的观察血液灌流联合长托宁对急性有机磷中毒患者血清高敏C反应蛋白(hs-CRP)和白细胞介素-18(IL-18)的影响。方法选择2014年2月—2016年2月中国医科大学附属盛京医院急诊科收治的急性有机磷中毒患者90例进行分析,采用随机数字表法分为对照组和观察组各45例,其中对照组采用血液灌流联合阿托品治疗,观察组采用血液灌流联合长托宁治疗。对2组患者治疗后的效果及炎性因子水平进行比较,同时观察不良反应发生情况。结果治疗后,观察组给药次数、总用药量、灌流次数、ChE复常时间、住院时间均明显少于/短于对照组(χ~2=10.628、10.723、4.072、7.510、3.887,P<0.05);观察组临床治愈率为93.33%,高于对照组的77.77%(χ~2=3.887,P=0.049);观察组患者ChE水平显著高于对照组(t=10.067,P=0.000);心电图均无显著变化(P>0.05)。治疗后,2组血清IL-6、IL-18、hs-CRP、TNF-α水平较治疗前均降低(P<0.05),且观察组低于对照组(t=2.374、2.089、9.287、4.373,P<0.05);观察组患者肌痛发生率为8.89%,明显低于对照组的22.22%(χ~2=4.735,P=0.030),而2组患者乏力、消化道反应及肝功能异常情况的发生率相比无明显差异(χ~2=2.532、1.707、4.750,P>0.05)。结论采用血液灌流联合长托宁对急性有机磷中毒患者进行治疗,疗效高,可以有效地降低患者的促炎因子水平,不良反应小。

Objective To explore the effects of c reactive protein and IL-18 for hemoperfusion combined penehyclidine hydrochloride in patients with acute organophosphorus poisoning.Methods Ninety cases with in patients with acute organophosphate poisoning from April 2014 to February 2016 were enrolled.According to random number table, they were divided into observation group and control group, 45 cases in each group.The control group was treated with hemoperfusion combined with atropine, and the observation group was treated with hemoperfusion combined with penehyclidine hydrochloride.The therapeutic effects of the two groups of patients before and after treatment and the level of inflammatory factors were compared, and the incidence of adverse reactions was observed.Results After treatment, the ChE level in the observation group higher than the control group （χ2=10.067,P=0.000）.After treatment, the observation group of patients with dosing frequency number, total dose, perfusion, ChE geomagnetic, length of hospital stay were significantly less than the control group [（χ2=10.628,P=0.000）;（χ2=10.723,P=0.001）;（χ2=4.072,P=0.044）;（χ2=7.510,P=0.751）;（χ2=3.887,P=0.049）].Observe the clinical cure rate was 93.33%, which was obviously higher than that of control group＇s 77.77% （t=3.887,P=0.049）.After treatment, two groups of patients with serum IL-6, IL-18, hs CRP, TNF alpha index levels significantly lower than before treatment （P〈0.05）, and the observation group＇s serum IL-6, IL-18, hs-CRP, TNF alpha indexes were significantly lower than that of control group [（t=2.374,P=0.019）;（t=2.089,P=0.040）;（t=9.287,P=0.000）;（t=4.373,P=0.000）].The incidence of muscle pain in patients was 8.88% in observation group, which was obviously lower in the control group of 22.22% （χ2=4.735,P=0.030）;the incidence of gastrointestinal reaction and liver function abnormalities compared between the 2 groups showed no significant difference [（χ2=2.532,P=0.112）;（χ2=1.707,P=0.191）;（χ2=4.750,P=0.029）].Conclusion Using hemoperfusion combined with penehy-clidine hydrochloride for acute organophosphate poisoning treatment showed high efficiency, it can effectively reduce the level of inflammatory cytokines in patients with mild side effects.