血液灌流联合解磷定治疗有机磷农药中毒的疗效及预后分析

Analysis on the therapeutic effect and prognosis of hemoperfusion plus pralidoxime for organophosphorus pesticide poisoning

目的:观察分析血液灌流联合解磷定治疗有机磷农药中毒患者的效果。方法:选取2015年5月~2017年3月我院急诊并住院治疗的96例有机磷农药中毒患者,随机分为实验组(48例)、对照组(48例),对照组采用解磷定+阿托品+对症处理的治疗方案,实验组在对照组治疗方案基础上联合应用血液灌流,观察分析2组患者疗效及预后。结果:实验组治愈率为91.67%,高于对照组(70.83%),重要脏器损害率低于对照组,差异均有统计学意义(P<0.05);实验组解磷定及阿托品用药量均低于对照组,差异均有统计学意义(P<0.05);实验组昏迷时间、阿托品化时间及住院时间均低于对照组,差异均有统计学意义(P<0.05);住院24、48、72 h后,实验组患者胆碱酯酶的活性高于对照组(P<0.05),实验组死亡、中间综合征及反跳发生率均低于对照组,差异均有统计学意义(P<0.05)。结论:血液灌流联合解磷定治疗急性重度有机磷农药中毒可在降低药物使用量的前提下,提高治愈率,降低病死率及并发症发生率,同时可缩短患者恢复时间。

Objective ：To observe the curative effect of combined hemoperfusion with pralidoxime in the treatment of organophosphorus pesticide poisoning. Methods：Ninety-six patients with organophosphorus pesticide poisoning treated in our department were included from May 2015 to April 2017, and randomized into experimental group （n = 48 ） and control group （n = 48 ） by random digital table.Patients in the control group received pralidoxime＋atropine ＋symptomatic therapy regimen, and those in the experimental group were treated with additional hemoperfusion on the basis of the protocol in the control group.Then two groups were compared concerning the therapeutic effect and prognosis.Results：The experimental group had higher curative rate than the control group（ 91.67% vs.70.83% ,P〈0.05）, as well as lower dose of pralidoxime and atropine, shorter time of coma and atropinization, shortened hospital stay, significantly higher activity of cholinesterase in 24 h, 48 h and 72 h after admission, and lower death and incidences of intermediate syndrome and rebound rate（ all P〈0.05）.Conclusion ：Combined hemoperfusion with pralidoxime for acute severe organophosphorus pesticide poisoning may improve the cure rate, reduce the mortality and complications as well as significantly facilitate early recovery in the context of reduced dosage of drugs.