治疗性血浆置换术救治重症急性有机磷中毒

Application of therapeutic plasma exchange to severe active organic phosphorus intoxication

目的 探讨治疗性血浆置换术 (TPE)在救治重症急性有机磷中毒中的作用。方法 对常规治疗中毒症状缓解不明显的 10例重症有机磷中毒患者施行TPE ,观察患者TPE前后各主要生化指标变化、患者神志开始和完全恢复时间 ,以确保疗效。结果 ①患者TPE后ChE、BUN、CK、CK -MB、ALT、AST、ALB、TC、TG等各项指标均较TPE前有明显改善 ;② 10例患者均在一次TPE后 8h内神志开始恢复 ,9例在 2 4h内完全恢复 ,其中 3例分离中即开始恢复 ,1例完全恢复。另有 1例行二次TPE后 4h完全恢复。结论 TPE救治重症急性有机磷中毒疗效显著 ,具有常规疗法无可比拟的优势 ,可及时、有效去除毒素 ,补充有活力胆碱酯酶及某些血浆正常成分 ,改善患者症状。

Objective To study the function of therapeutic plasma exchange (TPE)in severe active organic phosphorus intoxication treatment.Methods In routine treatment,syndrome relief of patients with severe active organic phosphorus intoxication was not obvious.We performed TPE for the cases and observed the changes of main biochemical index before and after TPE,the beginning time and complete recovery time of consciousness recovery, so as to determine treatment effect.Results ①After TPE,all kinds of indexes such as ChE,BUN,CK,CK-MB,ALT,AST,TC and TG were improved more obviously than before; ② 10 patients’ consciousness began to recover in 8 hours after TPE one time,9 patients recovered totally in 24 hours,three of them began to recover at partition, one case recovered totally.Another case recovered totally in 4 hours after TPE twice.Conclusion The treatment effect of TPE for severe active organic phosphorus intoxication is more significant and excellent than routine treatment,which could timely,effectively get rid of toxin,supply active cholinesterase and some plasma component, improve patients’ syndrome.