血液灌流对兔甲胺磷中毒血中毒物清除的实验研究

Effect of hemoperfusion on clearance of organophosphorus in rabbits poisoned by methamidophos

目的探讨血液灌流（hemoperfusion，HP）对兔甲胺磷中毒血中毒物的清除作用及对脏器的影响。方法健康日本大耳白兔16只，随机分为两组：灌流组和非灌流组，两组均予胃管灌注甲胺磷溶液20mg／kg体质量，灌流组在常规治疗基础上，予中毒后60min给予树脂血液灌流治疗；非灌流组仅给予洗胃、阿托品及胆碱酯酶复能剂等常规治疗。用气相色谱法测定染毒前、后不同时间点血中甲胺磷浓度；同时观察染毒后6h两组血胆碱酯酶（ChE）、谷丙转氨酶（ALT）、谷草转氨酶（AST）、乳酸脱氢酶（LDH）及心肌酶学（CK、CK-MB）的变化和肺、肝、肾、肌肉的病理学变化。实验所得结果均以均数±标准差（x±s）表示，采用SPSS10．0统计软件进行统计分析，灌流前后比较采用配对比较的t检验。两组间比较采用两样本均数比较的t检验。P〈0．05为差异具有统计学意义。结果①兔经胃管灌入甲胺磷后，均出现了典型的有机磷农药中毒症状。灌流组灌流前血甲胺磷质量浓度为（11．43±1．56）μg／mL，灌流30，60，90，120min血浆中甲胺磷质量浓度分别为（7．82±1．54），（4．97±1．58），（5．664-1．75），（5．49±1．68）μg／mL，与灌流前相比差异无统计学意义（P〈0．01）；并与同一时间点非灌流组相比差异具有统计学意义（P〈0．01）；灌流后中毒症状减轻；②两组兔中毒后血胆碱酯酶活性均出现明显下降，但差异无统计学意义（P〉0．05）；与灌流组相比，非灌流组血A坍，AST，LDH，CK和CK-MB明显升高（P〈0．01），③兔染毒后6h光镜下可见肌肉、肝、肾、肺组织出现不同程度损害，以非HP组明显。结论①血液灌流能有效清除血中甲胺磷含量，从而改善中毒后的临床症状；②早期积极HP治疗可减轻脏器损害，显示其对脏器的保护作用。

Objective To evaluate the clearance efficacy of resin hemoperfusion（HP） on the removal of organophosphorus in the rabbits poisoned by methamidophos（MAP） and its effects on organ injury. Method Sixteen healthy Japanese white rabbits were randomly divided into HP group and non-HP group. MAP was given through gastric tube in a dosage of 20 mg/kg to rabbits of both groups. Rabbits of HP group received resin hemopersion plus conventional treatment including early gastric lavage, atropine and pralidoxime. Rabbits of non-HP group received only conventional treatment. The plasma concentration of MAP was determined by using gas chromatography before and ＇after rabbits were poisoned at different intervals. Serum choline esterase （CUE）, lactic dehydrogenase （LDH）, alanine amlnotransferase （ALT）, aspartate aminotransferase （AST）, creatine kinase （CK） and creatine kinase isoenzyme （CK-MB） of rabbits of both groups were assayed 6 hours after rabbits poisoned. Pathological changes in lung, liver, kidney and muscle were investigated simutaneously. SPSS 10.0 software was used for statistical analysis. The comparison between groups was carried out by using t -test. Results① The typical symptoms of organophosphorus poisoning were occurred in rabbits within 5 - 10 minutes after ingestion of MAP. In HP group, the plasma levels of rabbits before, and 30 min,60 min,90 min and 120 min after hemoperfu- sion were （ 11.43 ± 1.56 ）, （ 7.82± 1.54）, （ 4.97 ± 1.58）, （5.66± 1.75 ）, （5.49± 1.68） μg/mL, respectively （ P 〈 0.01 ）. After hemoperfusion, the plasma MAP levels of rabbits in HP group were lower than those in non-HP groups （ P 〈 0.01 ）. The improvement of clinical presentation of rabbits was observed shortly after HP. ②The blood choline esterase activity of rabbits were depressed in both groups without significant difference. In contrast, the blood levels of ALT, AST, LDH, CK and CK-MB of rabbits in non-HP group elevated significantly than in HP group （ P 〈 0.01）. ③ The more severe injury of muscle, liver, kidnet and lung of rabbits can could be seen in non-HP group. Conclusions ① HP can effectively eliminate the plasma MAP and has the potential to improve the clinical presentation of intoxication in rabbits. ② Early intervention of HP exerts a protection from organ damage of organophosphorus pesticide.