床边血液灌流治疗急性甲胺磷中毒研究

The assessment of hemoperfusion for the trearment of acute methamidophos poisoning

目的探讨血液灌流（HP）对甲胺磷中毒患者体内毒物的清除效果。方法在综合治疗的基础上，对15例重度急性甲胺磷中毒患者予以HP治疗，在HP前，HP开始后5、15、30、45、60min及HP结束时（120rain）共7个时间点分别采集患者外周静脉血5ml，测定血清中甲胺磷浓度及血清胆碱酯酶活力，并测定HP后灌流器吸附的甲胺磷含量。结果15例患者存活12例，死亡3例。55例中毒患者HP前血胆碱酯酶活力为（662．60±632．05）IU／L，HP后血胆碱酯酶活力为（2577．52±920．38）IU／L，灌流前后血胆碱酯酶活力的差异有统计学意义（P〈0．01）。HP治疗后第45、60、120min时患者血中甲胺磷浓度分别为（851±672）、（680±529）、（587±520）μg／ml，明显低于HP前（1659±1105）μg／ml，差异有统计学意义（P〈0．01）。灌流器吸附甲胺磷含量阳性。结论HP可以明显降低甲胺磷中毒患者血清中毒物浓度，实验方法直接证明了临床应用HP的碳肾确能吸附甲胺磷。

Objective To explore the effect of hemoperfusion（HP） about the pacients of methamidophos poisoning. Methods On the basis of comprehensive treatment ,15 cases of severe acute methamidophos poisoning patients were treated with HP, Blood samples were collected at 7 time points, before and 5, 15, 30, 45, 60rains following the beginning and the end of hemoperfusion. Blood samples were used for measuring the concentration of methamidophos and perfusion devices were used for measuring the volume of methamidophos adsorbed by the device after hemoperfusion. Results 15 patients live in 12 cases, 3 cases of death. HP （former） blood Cholinesterase vigor were 662.60 ± 632.05, HP （after） blood cholinesterase vigor were 2577.52 ± 920.38 IU/L; The difference of blood Cholinesterase vigor between the before and after HP was statistically significant （P 〈 0.01）. The patients＇ methamidophos concentration of blood when HP treated 45, 60, 120 min were respectively （851 ± 672）, （680 ±529）, （587 ± 520） μg/ml, there were significantly lower than that the patients＇ methamidophos concentration of blood who were before HP （1659 ± 1105） μg/mi, a statistically significant difference （P 〈 0.01）. Conclusion HP can be cut down obviously methamidophos poisoning patients serum concentrations of toxic, the experimental method directly prove the clinical application of carbon HP can really adsorption methamidophos.