血液灌流治疗次数对重度急性有机磷农药中毒疗效和预后的影响

Influence of hemoperfusion frequency on therapeutic effect and prognosis of patients with severe acute organophosphorus poisoning

目的探讨重度急性有机磷农药中毒（AOPP）后进行血液灌流（HP）治疗次数与疗效和预后的相关性。方法将82例重度AOPP患者根据HP治疗次数分为3组：非HP组（25例）仅给予常规治疗；在常规治疗基础上，HP1组（27例）于中毒12 h内给予1次HP；HP2组（30例）给予2次及以上HP，每次间隔24 h。比较3组患者临床各指标、并发症发生率及病死率。结果随HP治疗次数的增加，患者阿托品和氯解磷定总用量明显减少，血清胆碱酯酶（ChE）活性恢复时间、恢复清醒时间、住院时间、机械通气时间明显缩短，入院48 h急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、并发症发生率及病死率明显降低（均P＜0.05）。与HP1组比较，HP2组阿托品总用量（mg：164.57±68.82比256.81±97.06）、氯解磷定总用量（mg：6.95±1.40比8.76±1.64）明显减少，ChE活性恢复时间（d：9.23±2.46比10.96±3.44）、恢复清醒时间（h：23.83±6.29比39.93±8.24）、住院时间（h：9.57±2.39比11.52±3.02）、机械通气时间（h：40.50±16.55比65.74±18.88）明显缩短，入院48 h APACHEⅡ评分（分：11.97±3.47比14.26±2.88）明显下降，并发中间综合征（10.0%比18.5%）、反跳现象（3.3%比25.9%）、心律失常（13.3%比44.4%）、多器官功能障碍综合征（MODS）的发生率（6.7%比29.6%）和病死率（6.7%比18.5%）均明显下降（均P＜0.05）。结论早期反复多次HP结合常规治疗可提高重度AOPP患者的临床疗效，降低病死率。

Objective To discuss the correlations between hemoperfusion（HP） times and therapeutic effects/prognosis in patients with severe acute organophosphorus poisoning（AOPP）. Methods According to the frequency of HP,82 patients with severe AOPP were divided into three groups：non HP（25 cases）,HP1（27 cases） and HP2（30 cases）groups. The non HP group received only routine treatment,on the basis of routine treatment,the HP1 group accepted once HP within 12 hours after poisoning and the HP2 group underwent twice or more times of HP,the interval between each time being 24 hours. The comparisions of clinical indexes,incidences of complications and rates of mortality among the three groups were performed. Results With the increase of HP times,the dosages of atropine and pralidoxime chloride were significantly reduced,the times of serum cholinesterase（ChE）activity recovery,consciousness recovery,hospitalization and mechanical ventilation were significantly shortened,the score of acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ）score in 48 hours after admission,incidence of complications and mortality were evidently decreased（all P〈0.05）. Compared with those in HP1 group,the dosages of atropine（mg：164.57±68.82 vs. 256.81±97.06）and pralidoxime chloride（mg：6.95±1.40 vs. 8.76±1.64） in HP2 group were significantly reduced,the times of ChE activity recovery（day：9.03±2.46 vs. 10.96±3.44）, consciousness recovery（hour：23.83±6.29 vs. 39.93±8.24）,hospitalization（hour：9.57±2.39 vs. 11.52±3.02） and mechanical ventilation（hour：40.50±16.55 vs. 65.74±18.88）in HP2 group were significantly shortened;APACHEⅡscore during 48 hours after admission（11.97±3.47 vs. 14.26±2.88）was obviously decreased,and the incidences of complications,such as intermediate syndrome（10.0% vs. 18.5%）,rebound phenomenon（3.3% vs. 25.9%）,arrhythmia（13.3%vs. 44.4%）,multiple organ dysfunction syndrome（MODS,6.7%vs. 29.6%）and mortality rate（6.7% vs. 18.5%）in HP2 group were markedly decreased（all P〈0.05）. Conclusion It is recommendable that combined with routine treatment,early and multiple HP application would enhance the therapeutic effect and decrease the mortality in patients with severe AOPP.