乌司他丁干预重症有机磷农药中毒的临床研究

Clinical study on ulinastatin intervention in severe acute organophosphorus pesticide poisoning

目的评价乌司他丁干预在防治急性有机磷农药中毒(AOPP)引发的多器官功能障碍综合征(MODs)及降低其病死率方面的作用。方法45例重症AOPP患者随机分为鸟司他丁干预组(n=23)和非乌司他丁干预组(n=22),观察两组治疗前后全血胆碱酯酶和肌酸激酶同工酶、动脉血气及血流动力学的变化,比较两组患者肺及肺外器官功能改善率、并发症发生率、ICU病死率及其死亡的原因等。结果两组患者的年龄、全血胆碱酯酶和APACHEⅡ评分比较,差异无统计学意义(P＞0．05)。乌司他丁干预组对重症AOPP患者的全血胆碱酯酶、肌酸激酶同工酶、动脉血气及血流动力学的影响均优于对照组,肺及肺外器官功能改善率明显优于对照组,机械通气相关肺炎(VAP)、心肌缺血和心律失常的发生率也均明显下降；鸟司他丁干预组因多器官功能衰竭(MOF)的ICU病死率为4．35%,明显优于对照纽(27．27%,P＜0．05),使重症AOPP患者ICU救治的痊愈率从72．73%提高到95．65%(P＜0．05)。结论乌司他丁干预能改善重症AOPP患者全血胆碱酯酶、肌酸激酶同工酶、动脉血气及血流动力学,降低VAP、心肌缺血和心律失常的发生率,在防治AOPP引发的MODS及降低其病死率方面有很好的临床效果。

Objective To evaluate the effects of ulinastatin on the prevention and treatment of multiple organ dysfunction syndreme （MODS） and the decrease of the mortality. Methods 45 patients of severe acute organophosphorus pesticide poisoning （AOPP） were randomly divided into ulinastatin intervention group and non - ulinastatin intervention group. We compared the changes of whole blood acetylcholine esterase, creatine kinase isoenzyme ,arterial blood gas （ ABG ） and hemodynamics of the two groups before and after the treatment . The functional improvement rate of lung and extra -pulmonm-y organs, complication incidence of mechanical ventilation, mortality in ICU and the causes of death were also compared. Results There were no significant differences in the age, whole blood acetylcholine esterase and acute physiology and chronic health evaluationⅡ（APACHEⅡ） scores of the two groups（ P 〉0.05） ;The effects of ulinastatin intervention on whole blood acetylcholine esterase, creatine kinase isoenzyme, ABG and hemodynamics in severe AOPP patients were superior to control group; The functional improvement rates of lung and extra - pulmonary organs in ulinastatin intervention group obviously outstripped those in control group ,and the incidence of ventilator -assoeiated pneumonia （ VAP）, myocardial ischemia and arrhythmia were also obviously decreased; The mortality of multiple organ failure of ulinastatin intervention group in ICU was 4.35%, which was obviously lower than that（27.27% ） of control group（ P 〈 0.05） ,and the recovery rate of severe AOPP in ICU increased from 72.73% to 95.65% （ P 〈 0.05 ）. Conclusion Ulinastatin intervention can improve the whole blood acetylcholine esterase, creatine kinase isoenzyme, ABG and hemodynamics of severe AOPP patients, and decrease the incidence of VAP, myocardial ischemia and arrhythmia,and has great clinical effects on the prevention and treatment of MODS induced by AOPP and the decrease of the mortality.