早期床旁紧急血液灌流在急性中毒一体化治疗中的临床应用研究

Significance of early emergent bedside hemoperfusion in integrated treatment of acute poisoning： a clinical study

目的研究早期旁紧急血液灌流在急性中毒一体化治疗中的意义。方法将急诊收治的各类中毒患者280例随机分为性别、年龄、中毒种类、从服毒至抢救时间及合并器官损害等情况无显著差异的两组：灌流组（n=150，于中毒后1．8h内进行血液灌流）和非灌流组（对照组，n=130，仅予以常规洗胃、导泻等一般性治疗）。观察两组在意识障碍恢复时间、肺水肿纠正时间、抽搐终止时间、解毒剂应用剂量及死亡例数、生化酶指标等方面的差异。结果灌流组意识障碍纠正时间为（3．0±0．5）h；肺水肿平均纠正时间为（2．5±0．4）h；抽搐终止时间为（9．7±1．2）h；有机磷中毒阿托品用量为（26±2．5）mg；死亡数为5例。均显著低于对照组[（6．5±0．8）h，（4．9±0．7）h，（18．5±4．2）h，（47±6．5）mg，12例，均P〈0．051。结论在急性中毒一体化治疗措施方法中，早期进行床旁血液灌流能明显改善中毒患者的生存质量，提高抢救成功率，值得在急诊临床大力推广应用。

Objective To study the significance of early emergent bedside hemoperfusion （HP） in the integrated treatment of acute poisoning. Method 280 patients with acute poisoning were randomly appointed to 2 two groups： HP Group （n= 150） undergoing early HP begun within 1.8 hours after the poisoning in addition to the routine treatment, and control group （n=130） undergoing only routine gastric lavage and laxation, and use of specific antidotes. The consciousness recovery time, pneumonedema rectification time, convulsion time, amount of antidote used, and mortality were observed and compared between these two groups. Results The consciousness recovery time, pneumonedema rectification time, and convulsion time of the HP group were （3±0.5）h, （2.5±0.4）h, and （9.7±1.2）h respectively, all significantly shorter than those of the control group ]（6.5±0.8）h, （4.9±0.7）h, and （18.5± 4.2） h respectively, all P〈 0.05]. The prescribed dosage of atropine for organophosphorous poisoning of the HP group was （26± 2.5）, significantly lower than that of the control group [（47±6.5） mg , P〈 0.05] . Five patients in the HP group died, a number significantly lower than that in the control group （12 cases, P〈0.05）. Conclusion In the integrated treatment of acute poisoning, early emergent bedside hemoperfusion increases the survival rate, and considerably improves patients＇ life quality after the survival; therefore, it is highly recommended that early bedside hemoperfusion should be widely applied in clinical practice.