血液灌流对急性重度有机磷中毒患者肠黏膜屏障功能的影响

Effect of hemoperfusion on intestinal barrier function in patients with acute organophosphorus pesticide poisoning

目的观察血液灌流(HP)对急性重度有机磷中毒(AOPP)患者肠黏膜屏障功能的影响。方法将40例AOPP患者随机分为灌流组和对照组,每组20例。对照组仅使用基础治疗;灌流组在使用基础治疗的基础上给予HP治疗。分别于灌流前、灌流后1~7 d评估2组患者的肠道功能并检测其血中有机磷含量、胆碱酯酶(Ach E)浓度、内毒素(LPS)及血浆中肠脂肪酸结合蛋白(I-FABP)。结果 HP治疗后7 d,灌流组肠道功能的评分明显低于对照组,差异有统计学意义(P<0.05)。灌流组HP治疗前血中有机磷含量为(2.07±0.18)μg/ml,HP治疗后血中未检测到有机磷,清除率为100.00%。对照组观察了10例的血中有机磷含量,发现治疗1 d后血中有机磷含量无变化。由于血中有机磷定量测定非常昂贵,本实验只检测了灌流前及灌流1 d后的有机磷含量,对照组其余10例未继续检测。HP治疗2 d后灌流组患者的血浆Ach E活力较对照组明显升高,差异均有统计学意义(P<0.05)。HP治疗后灌流组血LPS及I-FABP浓度均呈显著下降趋势,较治疗前及对照组均明显降低,差异均有统计学意义(P<0.01)。结论HP治疗AOPP可有效改善肠道黏膜屏障功能从而维护肠道功能,降低并发症发生率,提高临床治愈率,值得临床上推广应用。

Objective To study the effect of hemoperfusion（ HP） on intestinal barrier function in patients with acute organophosphorus pesticide poisoning（ AOPP）. Methods 40 patients with AOPP were randomly divided into hemoperfusion group and control group,20 cases in each group. Control group only used the basic treatment; hemoperfusion group was treated with HP on the basis of the basic treatment. The intestinal function of two groups was evaluated before perfusion and 1 ~ 7 days after perfusion. The levels of organic phosphorus content,cholinesterase（ Ach E） concentration,endotoxin（ LPS） and plasma intestinal fatty acid-binding protein（ I-FABP） in plasma were detected. Results At 7 days after HP treatment,the scores of intestinal function in hemoperfusion group were significantly lower than those in control group,the difference was statistically significant（ P〈0. 05）. In hemoperfusion group,the level of organophosphorus in blood before treatment was（ 2. 07 ± 0. 18） μg/ml,and no organic phosphorus was detected in the blood after HP treatment,the clearance rate was 100. 00%. In control group observed the blood of 10 cases of organic phosphorus content,found that 1 day after treatment of blood organic phosphorus content unchanged. Since the determination of organophosphorus in blood was very expensive,only the content of organophosphorus before perfusion and 1 day after perfusion was detected in this experiment,while the remaining 10 patients in control group did not continue the test. After 2 days of HP treatment,the plasma Ach E activity of hemoperfusion group was significantly higher than that of control group,the differences were statistically significant（ P〈0. 05）. After treatment with HP,the concentrations of LPS and I-FABP in hemoperfusion group decreased significantly,which were significantly lower than those before treatment and control group,the differences were statistically significant（ P〈0. 01）. Conclusion HP treatment for AOPP patients can effectively maintain the intestinal barrier and prevent intestinal dysfunction,reduce the incidence of complications,improve the clinical cure rate which is worthy of clinical popularization and application.