血液灌流联合血液透析治疗重症有机磷农药中毒的临床观察

Clinical effect of hemoperfusion combined with hemodialysis in treatment of severe organophosphate pesticide poisoning

目的 探讨血液灌流联合血液透析对重症有机磷农药中毒患者的临床疗效.方法 选取2005年3月至2013年9月来我院急诊科就诊的98例重度有机磷农药中毒患者的临床资料,按照救治措施分为对照组和治疗组两组,每组49例;对照组患者给予常规急救治疗,观察组患者在常规治疗的基础上给予血液灌流联合血液透析采用血液灌流;对比两组患者的临床疗效及并发症情况.结果 对照组35例治愈,14例死亡,治愈率为71.4％;治疗组治愈46例,死亡3例,治愈率93.9％;观察组治愈率明显高于对照组对照组(x2＝8.611,P＜0.05);且观察组的昏迷至清醒时间、平均住院时间、胆碱酯酶活力恢复时间及阿托品用量均较少于对照组(均P＜0.01).对照组出现尿潴留18例明显多于观察组的6例(x2＝4.991,P＜0.05);且对照组出现中间综合征、呼吸衰竭、迟发型神经损害、反跳例数均多于对照组.结论 血液灌流联合血液透析用于重症有机磷农药中毒患者的抢救治疗临床疗效好,且可显著减少患者并发症的发生,值得临床推广.

Objective To investigate the clinical effect of hemoperfusion combined with hemodialysis in the treatment of severe organophosphate pesticide poisoning.Methods Ninety-eight patients with severe organophosphate pesticide poisoning who were admitted to the emergency department of our hospital from March 2005 to September 2013 were equally divided into control group and observation group according to treatment methods.The control group was given conventional emergency treatment,while the observation group was given hemoperfusion combined with hemodialysis and the conventional emergency treatment.The clinical outcomes and complications of two groups were compared.Results In the control group,35 patients were cured and 14 patients died,so the cure rate was 71.4％.In the treatment group,46 patients were cured and 3 patients died,so the cure rate was 93.9％.The treatment group had a significantly higher cure rate than the control group (x2=8.611,P＜0.05).And the treatment group had significantly shorter duration of coma (P＜0.01),mean length of hospital stay (P＜0.01),and time to recovery of cholinesterase activity (P＜0.01) and a significantly reduced dose of atropine than the control group (P＜0.01).The control group had significantly more cases of urinary retention than the treatment group (18 vs.6,x2=4.991,P＜0.05).And the control group had more cases of intermediate syndrome,respiratory failure,delayed neurological damage,and rebound than the treatment group.Conclusion Hemoperfusion combined hemodialysis has a good clinical effect and causes fewer complications in treating severe organophosphate pesticide poisoning,so it is worthy of clinical promotion.