碳酸氢钠联合乌司他丁治疗急性辛硫磷农药中毒胆碱酯酶活力的变化

The influence of sodium bicarbonate combined with ulinastatin on cholinesterase activity for patientswith acute phoxim pesticide poisoning

目的观察碳酸氢钠联合乌司他丁治疗急性辛硫磷农药中毒胆碱酯酶活力的影响。方法2011年3月至2014年2月于我院急诊科病房住院治疗且符合研究条件的急性辛硫磷农药中毒患者69例，按治疗方法不同分为常规治疗组34例，碳酸氢钠＋乌司他丁组35例。两组均给予导泻、吸氧、补液、利尿、解毒药物阿托品和氯解磷定等治疗措施。常规治疗组给予清水彻底洗胃，碳酸氢钠＋乌司他丁组采用2％碳酸氢钠溶液洗胃。碳酸氢钠＋乌司他丁组在综合治疗的基础上，加用5％碳酸氢钠注射液联合乌司他丁治疗，对比两组患者的胆碱酯酶活力的变化。结果碳酸氢钠＋乌司他丁组第5、7、10天及出院时血胆碱酯酶活力明显高于常规治疗组，差异有统计学意义（P〈0．05）；碳酸氢钠＋乌司他丁组阿托品总用量、氯解磷定总用量、住院时间均低于常规治疗组，差异有统计学意义（P〈O．05）；两组阿托品化时间的差异无统计学意义（P〉0．05）。碳酸氢钠＋乌司他丁组动脉血第10天HCO3-明显高于常规治疗组，差异有统计学意义（P〈0．05）。结论碳酸氢钠联合乌司他丁治疗急性辛硫磷农药中毒，可提高疗效，减少并发症，对胆碱酯酶活力恢复有作用。

Objective To observe the effect of sodium bicarbonate combined with ulinastatin on cholinesterase activity for patients with acute phoxim pesticide poisoning. Methods A total of 67 eligible patients with acute phoxim pesticide poisoning, Who were admitted to the emeryency department of hospital from March 2011 to February 2014, Acording to different treatments au patients were randomly divided into the conventional treatment group （n=34） and the sodium bicarbonate＋ulinastatin group （n=35）. The conventional treatment group were given thorough gastric lavage with water, the sodium bicarbonate ＋ ulinastatin group were given gastric lavage with 2% sodium bicarbonate solution. Both groups were given such treatments as catharsis, administration of oxygen, fluid infusion, diuresis, and antidotes such as atropine and pralidoxime methylchloride. On the basis of comprehensive treatment, people in the sodium bicarbonate＋ulinastatin group were given 5% sodium bicarbonate injection and ulinastatin. The clinical effect of the two groups were compared. Results The serum cholinesterase activity of the sodium bicarbonate ＋ulinastatin group was significantly higher than the conventional treatment group from the 5th day, and the difference was statistically significant（P〈0.05 ）. The total atropine dosage, total pralidoxime methylchloride dosage and hospitalization days were better than the conventional treatment group, and the differences were statistically significant （P〈0.05）. The difference in the time of atropinization between the two groups was not statistically significant （P〉0.05）. The results of arterial blood pH, HCO3- of the sodium bicarbonate ＋ ulinastatin group were higher than the conventional treatment group, and the difference of HCO3- at the 10th day was statistically significant （P〈0.05）. Conclusions Sodium bicarbonate combined with ulinastatin can improve the therapeutic effect and reduce complications in the treatment of acute phoxim pesticide poisoning, and have beneficial effects on the recovery of cholinesterase activity.