血液透析联合血液灌流在急性重度有机磷农药中毒患者抢救中的应用价值

The application value of hemodialysis combined with hemoperfusion in the treatment of acute severe organophosphorus pesticide poisoning

目的探究血液透析联合血液灌流治疗急性重度有机磷农药中毒患者的临床效果。方法采用随机数表法将2011年6月至2015年6月本院收治的100例急性重度有机磷农药中毒患者分为联合组和常规组,每组各50例。常规组患者给予清洗皮肤、洗胃、导泻、胃黏膜保护剂等常规治疗,联合组患者在常规组治疗基础上采用血液透析联合血液灌流治疗。比较两组患者阿托品用量、苏醒时间、住院时间、多脏器衰竭发生率及治疗前后胆碱酯酶活性。结果两组患者治愈率及死亡率比较差异均具有显著性(P<0.05)。联合组患者阿托品用量少于常规组,苏醒时间、住院时间均短于常规组,多脏器衰竭发生率低于常规组(P<0.05)。治疗前两组患者胆碱酯酶活性比较差异无显著性(P>0.05),治疗后联合组患者胆碱酯酶活性显著高于常规组(P<0.05)。结论血液灌流联合血液透析能够有效改善急性重度有机磷农药中毒患者的预后,减少阿托品用量,加速患者恢复,避免多脏器衰竭的发生,值得临床推广应用。

Objective To explore the clinical effect of hemodialysis combined with hemoperfusion in the treatment of acute severe organophosphorus pesticide poisoning.Method 100 cases of acute severe organophosphorus pesticide poisoning patients admitted in our hospital from June 2011 to June 2015 were divided into combined group and conventional group according to the random number table method,50 cases in each group.Conventional group patients were treated with gastric lavage and catharsis,cleaning skin,protecting gastric mucosa and other conventional treatment.In addition to the routine treatments,combined group patients were treated with hemodialysis combined with hemoperfusion.Compared the dosage of atropine,recovery time,hospitalization time,the incidence of multiple organ failure and choiinesterase activity of the two groups before and after treatment.Result The differences of cure rate and mortality rate between the two groups were significant（P 〈0.05）.Combined group patients with atropine dosage were less than control group,the recovery time,hospitalization time weres shorter than control group,multiple organ failure rate were lower than conventional group {P 〈0.05）.Two groups of patients before treatment of choiinesterase activity had no obvious difference（P 〉0.05）.and the choiinesterase activity of combined group was significantly higher than conventional group after treatment {P 〈0.05）.Conclusion Hemoperfusion combined with hemodialysis can effectively improve the prognosis of patients with severe acute organophosphorus pesticide poisoning,reduce the dosage of atropine,accelerate the recovery of the patients,avoid multiple organ failure,worthy of clinical application.