序贯性血液净化对急性有机磷农药中毒患者心功能的影响

Sequential blood purification effects on cardiac function in patients with acute organophosphorus pesticide poisoning

目的 探讨序贯性血液净化[血液灌流（HP）＋连续性静脉-静脉血液滤过（CVVH）]对急性有机磷农药中毒（AOPP）患者心功能的影响及其应用价值.方法 以45例重症AOPP并中毒性心肌炎患者为研究对象,按随机数字表法分为对照组22例,给予常规内科治疗＋HP;治疗组23例,给予常规内科治疗和HP＋ CVVH.观察两组患者治疗前及治疗后24,48,72 h,各时点左室射血分数（LVEF）、血浆B型脑钠肽（BNP）水平的差异.结果 两组患者治疗前LVEF[（47.7±9.8）％比（47.3±10.2）％]及BNP[（511.3±285.3） ng/L比（535.4±303.9） ng/L]比较差异均无统计学意义（P＞0.05）.治疗组较对照组治疗后各时点LVEF均增大[（52.7±7.3）％比（47.8±8.4）％、（55.2±5.2）％比（50.6±7.1）％、（60.7±6.3）％比（53.3±5.2）％,P＜ 0.05或＜0.01],BNP均减小[（320.7±181.8） ng/L比（496.7±268.9）n g/L、（252.7±113.8）n g/L比（384.3±167.5）n g/L、（122.4±66.7） ng/L比（294.8±121.8） ng/L],差异有统计学意义（P＜0.05或＜0.01）.治疗组治疗后各时点与治疗前比较,LVEF均增大[（52.7±7.3）％、（55.2±5.2）％、（60.7±6.3）％比（47.7±9.8）％],BNP均减小[（320.7±181.8）、（252.7±113.8）、（122.4±66.7） ng/L比（511.3±285.3） ng/L],差异有统计学意义（P＜0.01）.对照组LVEF和BNP治疗后24 h与治疗前比较差异无统计学意义[（47.8±8.4）％比（47.3±10.2）％、（496.7±268.9） ng/L比（535.4±303.9） ng/L]（P＞ 0.05）;治疗后48,72 h与治疗前比较,LVEF均增大[（50.6±7.1）％、（53.3±5.2）％比（47.3±10.2）％],BNP均减小[（384.3±167.5）、（294.8±121.8） ng/L比（535.4±303.9） ng/L],差异有统计学意义（P＜ 0.05或＜0.01）.结论 序贯性血液净化治疗能够减轻AOPP患者的心肌损伤,改善心功能.

Objective To investigate the effects of sequential blood purification on cardiac function in patients with acute organophosphorus pesticide poisoning （AOPP）,and to analyze its application value.Methods Forty-five patients with severe AOPP and toxic myocarditis were researched and randomly divided into two groups.Sequential blood purification included hemoperfusion（HP） and continuous veno-venous hemofiltration （CVVH）.In treatment group,23 patients were treated with HP ＋ CVVH on the basis of the conventional therapy.Twenty-two patients of control group received the conventional therapy with HP.The differences of two groups on left ventricular ejection fraction （LVEF） and B-type natriuretic peptide （BNP） were compared before treatment and at 24,48 and 72 h after treatment.Results Before treatment,the levels of LVEF and BNP in treatment group were （47.7 ± 9.8）% and （511.3 ± 285.3） ng/L,in control group were （47.3 ± 10.2）% and （535.4 ± 303.9） ng/L,and there were no significant differences （P 〉 0.05）.The levels of LVEF at each time point after treatment in treatment group were significantly higher than those of control group：（52.7 ± 7.3） % vs.（47.8 ± 8.4）%,（55.2 ± 5.2）% vs.（50.6 ± 7.1）%,（60.7 ± 6.3）% vs.（53.3 ± 5.2）%,and the levels of BNP in treatment group were significantly lower than those of control group：（320.7 ± 181.8） ng/L vs.（496.7 ±268.9） ng/L,（252.7 ±113.8） ng/L vs.（384.3 ±167.5） ng/L,（122.4 ±66.7） ng/L vs.（294.8 ± 121.8） ng/L,there were significant differences between two groups （P〈 0.05 or 〈 0.01）.In treatment group,the levels of LVEF at 24,48 and 72 h after treatment were significantly increased：（52.7 ± 7.3）%,（55.2 ± 5.2）%,（60.7 ± 6.3）% vs.（47.7 ± 9.8）%,and the levels of BNP were significantly decreased：（320.7 ± 181.8）,（252.7 ± 113.8）,（122.4 ±66.7） ng/L vs.（511.3 ±285.3） ng/L,there were significant differences （P 〈 0.01）.In control group,the levels of LVEF and BNP at 24 h after treatment were （47.8 ± 8.4）% and （496.7 ± 268.9） ng/L,before treatment were （47.3 ± 10.2）% and （535.4 ± 303.9） ng/L,and there were no significant differences （P 〉 0.05）;the levels of LVEF at 48 and 72 h after treatment were significantly increased：（50.6 ± 7.1）%,（53.3 ± 5.2）% vs.（47.3 ± 10.2）%,the levels of BNP were significantly decreased：（384.3 ± 167.5）,（294.8 ± 121.8） ng/L vs.（535.4 ± 303.9） ng/L,and there were significantl differences （P 〈 0.05 or 〈 0.01）.Conclusion Sequential blood purification treatment of AOPP can reduce myocardial injury and improve the cardiac function.