血液灌流对重度有机磷农药中毒疗效的临床观察

Clinical observation on the therapeutic effect of hemoperfusion combined with routine treatment for severe organophosphorus pesticide poisoning

目的探讨血液灌流治疗重度有机磷农药中毒的疗效及对胆碱酯酶(cholinesterase,ChE)活性恢复和炎症介质包括C反应蛋白(C-reactive protein,CRP)及白细胞介素6(interleukin-6,IL-6)的影响。方法回顾性分析四川省眉山市人民医院2013年6月至2016年1月期间收治的重度有机磷农药中毒患者64例,其中32例行血液灌流,32例未行血液灌流。2组患者均于入院后采用常规治疗,对照组给予阿托品和氯解磷定治疗,观察组在对照组基础上联合血液灌流治疗,灌流器为HA330。比较2组患者治疗前、后血清ChE水平变化,ChE活性恢复时间、中枢神经症状持续时间、N样症状持续时间、M样症状持续时间、住院时间及治疗前、后血浆CRP和IL-6水平变化。结果 2组治疗后血清ChE水平增加(P<0.05);观察组治疗后血清ChE水平高于对照组(P<0.05);观察组ChE活性恢复时间短于对照组(P<0.05);观察组中枢神经症状持续时间、N样症状持续时间、M样症状持续时间及住院时间和病死率均短于对照组(P<0.05);2组治疗后血浆CRP和IL-6水平下降(P<0.05);观察组治疗后血浆CRP和IL-6水平低于对照组(P<0.05)。结论血液灌流治疗重度有机磷农药中毒效果明显,明显促进ChE活性恢复,且可降低血清CRP和IL-6水平,成功率高,具有重要临床应用价值。

Objective To investigate the therapeutic effectiveness of hemoperfusion in the treatment of patients with severe organophosphorus pesticide poisoning and its effect on the recovery of ChE activity and inflammatory factors. Methods Sixty-four cases of severe organophosphorus pesticide poisoning were selected from our hospital from June 2013 to January 2016,and were randomly divided into observation group（ 32cases） and control group（ 32 cases）. The two groups were treated with routine treatment. The control group was given atropine and pyraloxime methylchride treatment,and the observation group was treated with the combination of hemoperfusion on the basis of the control group. The changes in serum ChE levels in two groups were compared before and after treatment. ChE activity recovery time,the duration of symptoms of central nervous system,N like,M like duration of symptoms,duration of symptoms,hospital stay and mortality,changes in serum CRP and IL-6 levels before and after treatment were measured. Results Serum ChE levels were increased after treatment in the two groups（ P〈0. 05）. Serum ChE levels after treatment in the observation group were higher than in the control group（ P〈0. 05）. ChE activity in the observation group recovered faster than in the control group（ P〈0. 05）. The central nervous symptom duration,the duration of N like symptoms and M symptoms,and hospital stay were significantly shorter in the observation group than in the control group（ P〈0. 05）. After treatment,serum CRP and IL-6 levels were significantly reduced in both two groups（ P〈0. 05）. Serum CRP and IL-6 levels after treatment were lower in the observation group than in the control group（ P〈0. 05）. Conclusions The effect of hemoperfusion in the treatment of organophosphorus pesticide poisoning patients is significant,which can significantly improve the recovery of ChE activity,and can reduce the levels of serum CRP and IL-6.