序贯性血液净化治疗重度有机磷农药中毒的临床研究

Sequential hemoperfusion and continuous veno-venous hemofiltration in treatment of severe organophosphorus pesticide poisoning

目的:探讨血液灌流(HP)序贯连续性静脉-静脉血液滤过(CVVH)治疗重度有机磷农药中毒临床疗效及可能机制。方法:88例急性重度有机磷农药中毒患者根据血液净化方式分为两组,对照组采用常规综合治疗+HP治疗,观察组在此基础序贯CVVH治疗,观察两组患者治愈率及相关临床指标,并比较两组血清肿瘤坏死因子-α(TNF-α)、白细胞介素1β(IL-1β)、干扰素-γ(IFN-γ)及白细胞介素4(IL-4)的水平。结果:对照组治愈36例(85.71%),观察组治愈42例(91.30%),观察组治愈率高于对照组,但无统计学差异(P>0.05);观察组昏迷时间、CHE活性恢复60%的时间、住ICU的时间、住院时间均明显短于对照组,差异有统计学意义(P均<0.05);治疗前两组患者血清TNF-α、IL-1β、IFN-γ及IL-4水平均无明显差异,治疗后24h上述炎症介质水平均有明显下降(P<0.05),且观察组明显低于对照组(P<0.05)。结论:HP序贯CVVH治疗重度有机磷中毒能有效缓解临床症状,有效持续清除炎症介质,提高治疗效果。

Objective：To investigate the effects of sequential hemoperfusion（HP） and continuous veno-venous hemofiltration（CVVH）on severe organophosphorus pesticide poisoning and its mechanism. Methods： Eighty eight patients with acute severe organophosphorus pesticide poisoning were divided into two groups, the control group was treated with conventional combined therapy and HP, while the observation group was also given the sequential HP and CVVH based on the conventional treatment. The cure rates and related clinical indicators and levels of TNF-a, IL-1β,IFN-γ and IL-4 were observed and compared between the two groups. Results： After treatment, the cure rate of the control group and observation group was 85.71% （18/21） vs. 91.30% （21/23）, respectively showing no significant difference between the two groups （P〉0.05）. Length of coma and 60% CHE activity recovery time, ICU stay, as well as hospitalization time of the observation group were significantly shorter than that of the control group, the difference was statistically significant （P〈0.05）. Before treatment, no significant difference in levels of serum TNF-a, IL-1β, IFN-γ and IL-4 were found between the two groups after 24 h of treatment, the levels of the above mentioned inflammatory mediators were significantly reduced （P〈0.05）, and those levels of observation group were lower than that of the control group （P〈0.05）. Conclusion： Sequential hernoperfusion and continuous veno-venous hemofiltration can improve symptoms of severe organophos-phate poisoning by reducing inflammatory mediators levels.