血液灌流治疗急性有机磷农药中毒中间综合征的疗效研究

Efficacy study of hemoperfusion in treating intermediate syndrome following acute organophosphorus pesticide poisoning

目的探讨血液灌流对急性有机磷农药中毒中间综合征（ＩＭＳ）患者血中有机磷的清除作用及临床疗效。方法２０例ＩＭＳ患者随机分为灌流组和非灌流组。灌流组在综合治疗基础上，除用解磷定外，同时予以血液灌流治疗，并用固相萃取技术进行色谱定量分析灌流前后患者血中有机磷含量。非灌流组在综合治疗基础上单用解磷定。通过观察灌流前后血中有机磷含量的变化、存活率、ＩＭＳ病程及呼吸肌麻痹发生率４项指标来判断血液灌流的临床疗效。结果灌流组存活率１００％，显著优于非灌流组（３０％，Ｐ＜０．０１）。ＩＭＳ病程明显短于非灌流组（Ｐ＜０．０５）。血液灌流后无一例发生呼吸肌麻痹，非灌流组均出现呼吸肌麻痹。 ８例血液灌流２ ｈ有机磷清除率为 １００％，２例灌流 １ｈ清除率分别为 ８０．１％和６５．５％。结论血液灌流能有效清除体内有机磷。血液灌流治疗急性有机磷农药中毒中间综合征疗效显著。

Objective To investigate the clearance of organophosphorus pesticide(OP) by hemoperfusion from the blood of patients with intermediate syndrome (IMS) following acute organophosphorus pesticide poisoning (AOPP) and its clinical efficacy. Methods Twenty cases with IMS following AOPP were divided randomly into hemoperfusion group and non-hemoperfusion group. The hemoperfusion group was treated with pralidoxime plus hemoperfusion. Organophosphorus pecticide blood concentration was detected before and after hemoperfusion. The non-hemoperfusion group was treated with pralidoxime alone. The following parameters were observed: changes of OP blood concentration after hemoperfusion, survival rate, clinical course, incidence of paralysis of respiratory muscles. Results in hemoperfusion group, the surviral rate was 100%, markedly superior to non-hemoperfusion group (30%, P < 0.01 ); the clinical course of IMS was significantly shorter than that of non-hemoperfusion group(P < 0. 05); no case with paralysis of respiratory muscles was found. Clearance rate of organophosphorus pesticide was 100% in & cases with 2 hours hemoperfusion, 80. 1%, 65. 5% in 2 cases with 1 hour hemoperfusion. Conclusions Hemoperfusion is an effective therapy for removing organophosphorus pesticide from the blood. There is an obvious efficacy of hemoperfusion in treating IMS following AOPP.