脂肪乳对重度急性有机磷中毒所致心肌损伤的疗效分析

Analysis of therapeutic effect of lipid emulsion for myocardial infarction in acute severe organophosphorus pesticide poisoning

目的：观察脂肪乳对重度急性有机磷中毒（ AOPP）所致心肌损伤的疗效。方法将136例重度AOPP所致心肌损伤的患者随机分为两组：对照组65例，给予常规洗胃、导泻、解毒药物及血液灌流等常规治疗。治疗组71例，在对照组基础上静脉输注脂肪乳。对比观察两组患者的血清肌酸激酶（CK）、肌酸激酶同工酶（CK－MB）、乳酸脱氢酶（LDH）、谷草转氨酶（AST）的水平、全血乙酰胆碱酯酶（ ChE）活性，死亡率及入住急诊监护室（ EICU）的时间。结果治疗组患者中毒后的第3、5、7天ChE活性水平高于对照组（P＜0．05）；脂肪乳在心肌损伤方面显示良好的治疗效应，患者血清CK、CK－MB、LDH、AST的水平明显下降，与对照组比较差异有统计学意义（P＜0．01）。与对照组比较，治疗组患者死亡率更低、EICU住院时间更短，差异有统计学意义（P＜0．05）。结论脂肪乳可明显降低心肌酶谱升高的程度，加快胆碱酯酶恢复，减轻重度AOPP导致的心肌损伤程度，进而起到保护心肌的作用，降低死亡率，缩短EICU住院时间。

Objective To explore the therapeutic effect of lipid emulsion for myocardial infarction in acute severe organophosphorus pesticide poisoning .Methods One hundred and thirty-six cases with myocardial infarction in acute severe organophosphorus pesticide poisoning were randomly divided into control group and treatment group .The control group contains 65 patients , which were given routine treatment, for example gastric lavage, cathartic, antidote, hemoperfusion.The treatment group contains 71 patients, received lipid emulsion by intravenous instillation on the basis of routine treatment . The death rate , the duration of EICU stays , and myocardial infarction indexes which contains creatine kinase （ CK ） , creatine kinase isoenzyme （ CK -MB ） , lactate dehydrogenase （ LDH ） , aspertate aminotransferase （AST）, acetyl cholinesterase （ChE）, were compared between two groups .Results The acetyl cholinesterase activity level in treatment group was much higher than that in control group with significant difference （P〈0.05） after organophosphorus pesticide poisoning , at 3, 5, 7 d which were the observation points .The myocardial infarction indexes , CK, CK-MB, LDH, and AST in treatment group were superior to control group （P〈0.01） after lipid emulsion treatment.In the treatment group, the death rate was decreased largrly , and the duration of EICU stays were shorter compared with the control group （ P 〈0.05 ）.Conclusion The lipid emulsion can reduce the degree of elevated myocardial enzymes , accelerate the resume of the activity of ChE in blood , and relieve the myocardial infarction induced by acute severe organophosphorus pesticide poisoning , decrease the death rate and shorten the duration of EICU stays .