血液灌流与大剂量纳洛酮联合治疗阿维菌素中毒的临床研究

Clinical Study of Hemoperfusion Combined with Large Dose of Naloxone for the Treatment of Avermectin Intoxication

【目的】探讨血液灌流与大剂量纳洛酮联合治疗阿维菌素中毒的疗效。【方法】选取收治于本科的40例口服阿维茵素重度中毒患者，随机分为对照组与治疗组，两组病人均予以洗胃、补液、利尿、预防感染、吸痰，使用地塞米松、血液灌流等常规处理，治疗组在此基础应用大剂量纳洛酮治疗。观察两组患者治疗72h后疗效；意识恢复需要的时间；自主呼吸恢复平稳所需时间；血压恢复稳定需要的时间；治疗24h后动脉血乳酸清除率。【结果】对照组的病死率高于治疗组的病死率，但两组相比较差异无显著性（P〉0．05）；治疗组的总有效率高于对照组，两组的总有效率相比较差异具有显著性（P〈O．05）。治疗组在患者的神志转清时间，自主呼吸及血压恢复平稳时间上均明显短于对照组，且差异具有统计学意义（P〈0．05）。治疗组的24h乳酸清除率明显高于对照组，差异具有统计学意义（P〈0．05）。【结论】血液灌流联合大剂量纳洛酮可以更快的稳定患者的生命体征，改善组织的缺血缺氧状态，明显地提高了治疗的总有效率，降低了患者的病死率。

[Objective] To explore the efficacy of hemoperfusion combined with large dose of naloxone for the treatment of avermeetin intoxication. [Methods]Forty patients with severe avermectin intoxication admitted to our department were randomly divided into control group and treatment group. Patients in both groups re- ceived routine methods such as gastrolavage, fluid replacement, diureses, infection prevention, sputum aspira- tion, dexamethasone and hemoperfusion. The treatment group was additionally given large dose of naloxone on this basis. The therapeutic efficacy after 72 hours, the time of consciousness recovery, spontaneously breath- ing recovery and blood pressure recovery and arterial blood lactate clearance rate after 24 hours of the treatment were observed. [Results]The case fatality rate in the control group was higher than that in the treatment group, but there was significant difference between two groups（ P ~0. 05）. The total effective rate of the treatment group was higher than that of the control group, and there was significant difference（ 19 d0.05）. The time of consciousness recovery, spontaneously breathing recovery and blood pressure recovery in the treat- ment group were obviously shorter than those in the control group, and there was significant difference（ P 0.05）. The 24h-lactate clearance rate in the treatment group was obviously higher than that in the control group（ P d0. 05）. [Conclusion] Hemoperfusion combined with large dose of naloxone can more quickly stabi- lize the vital signs, improve＇the tissue ischemic and hypoxia state, obviously elevate the total effective rate and reduce the case-fatality rate of the patients.