血液灌流抢救急性重度有机磷农药中毒的时机研究

The study of hemoperfusion treatment time of patient with acute serious organophosphorus pesticide

目的探讨急性重度有机磷农药中毒（ASOPP）血液灌流治疗的时机。方法将104例ASOPP患者随机分为对照组（采用内科常规治疗，46例）与HP组（采用内科常规治疗＋血液灌流，58例；再根据血液灌流时机分为HP-1、HP-2、HP-3组），观察各组患者意识恢复清醒时间、治愈率、病死率等指标。结果对照组、HP-1组、HP-2组、HP-3组的意识恢复清醒时间分别是（83．8±31.3）、（52．1±22．6）、（61．3±20．7）、（62．6±23．3）h，血清胆碱酯酶（ChE）恢复正常时间分别是（8．8±1．6）、（6．1±1.3）、（7．1±1．5）、（7．3±1．8）d，阿托品总用量分别是（769．3±186．5）、（489．8±123．9）、（539．5±143．3）、（523．3±118．7）mg，住院总时间分别是（13．9±2．3）、（9．8±1．3）、（11．5±1．6）、（11．9±1．8）d，治愈率分别是78.26％、96．55％、94．74％、91．67％，病死率分别是21．74％、3．45％、5．26％、8．33％。与对照组比较，HP—1、HP-2、HP-3组的意识恢复清醒时间短、ChE恢复快、阿托品总用量少、住院总时间短（P〈0．05）；治愈率、病死率HP-1、HP-2、HP-3组分别与对照组比较差异尚无统计学意义（P〉0．05）。与HP-1组比较，HP-2组及HP-3组的ChE恢复正常时间、意识恢复清醒时间及住院总时间均长，阿托品总用量多（P〈0．05）；但是治愈率、病死率差异尚无统计学意义（P〉0．05）。HP-2组与HP-3组比较，上述各个指标差异均无统计学意义（P〉0．05）。结论ASOPP在中毒4～32h内加用血液灌流治疗可以提高抢救疗效；但是以早期行血液灌流（4-8h）疗效最好。

Objective To explore the time of application ofhemoperfusion （HP） for the treatment of acute serious organophosphorus pesticide （ASOPP）. Methods One hundred and four patients with ASOPP were randomly divided into two groups, 46 patients accepted traditional treatment（control group）, 58 patients were treated with traditional treatment and HP （HP group）. The patients in HP group were again divided into three groups according the different time of treatment （time of beginning HP after poisoning）, the 4-8 hours group （HP-1 group, 27 patients）,the 9-16 hours group（HP-2 group, 19 patients）,the 17-32 hours group （HP-3 group, 12 patients ）.The coma period, the dosage of atropine, the time of regaining the vitality of chohnesterase, the time of hospitalization and the rate of fatality and curing among groups were observed. Resuits The coma period, the dosage of atropine, the time of regaining the vitality of cholinesterase, the time of hospitalization and the rate of fatality of the HP group were less than those of the control group （P 〈 0.05）. Compared with HP-1 group, the coma period, the dosage of atropine, the time of regaining the vitality of cholinesterase and the time of hospitalization of the HP-2 group and the HP-3 group were higher （P 〈 0.05）, but the difference of the rate of fatality and curing between the HP-1 group and the other HP groups was not statistically significant （P 〉0.05）. The difference of all of the above indicators between HP-2 group and HP-3 group was not statistically significant （P 〉 0.05）. Conclusion Application of hemoperfusion among 4-32 hours after poisoning for the treatment of ASOPP can improve the efficacy of therapy, and the efficacy of application of hemoperfusion among 4-8 hours is the best.