血浆置换联合血液灌流治疗急性有机磷农药中毒的效果分析

Effect Analysis of Plasma Exchange Combined with Hemoperfusion in the Treatment of Acute Organophosphorus Pesticide Poisoning

目的:探讨血浆置换(PE)联合血液灌流(HP)治疗急性重度有机磷农药中毒(ASOPP)的效果。方法:选取2014年5月-2017年6月笔者所在医院收治的138例ASOPP患者为研究对象,随机分为对照组(69例)和观察组(69例),对照组采取洗胃、导泻等常规治疗,观察组在对照组基础上采取PE联合HP治疗,观察比较急两组患者的临床治愈率、住院时间、昏迷时间、并发症发生情况、治疗不同时间胆碱酯酶(CHE)水平及肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-1β、IL-6、IL-8炎性因子水平。结果:观察组临床治愈率显著高于对照组,住院时间、昏迷时间显著短于对照组,比较差异均有统计学意义(P<0.05);观察组并发症发生率显著低于对照组,比较差异有统计学意义(P<0.05);两组治疗后随时间延长CHE均逐渐升高,且观察组治疗后6、24、36 h时的CHE水平均高于对照组,比较差异均有统计学意义(P<0.05);治疗后观察组患者的TNF-α、IL-1β、IL-6、IL-8水平均低于对照组,比较差异均有统计学意义(P<0.05)。结论:PE联合HP治疗ASOPP临床治愈率高,患者住院时间与昏迷时间较短且并发症低,临床指标恢复较快。

Objective：To investigate the efficacy of plasma exchange（PE） combined with hemoperfusion（HP） in the treatment of acute severe organophosphorus pesticide poisoning（ASOPP）.Method：From May 2014 to June 2017,the clinical data of 136 ASOPP patients admitted to author＇s hospital were selected and randomly divided into a control group（69 cases） and an observation group（69 cases）.The control group was given the gastric lavage and catharsis and other conventional treatment,the observation group was given PE combined with HP treatment on the basis of the control group.The clinical cure rate,hospitalization time,duration of coma,the incidence of complications,the level of cholinesterase（CHE） at different times,tumor necrosis factor alpha（TNF-alpha）,interleukin（IL）-1,IL-6 and IL-8 of two groups were compared.Result：The clinical cure rate in the observation group was significantly higher than that in the control group,the time of hospitalization and coma were significantly shorter than those in the control group,the difference were statistically significant（P〈0.05）.The incidence of complications in the observation group was significantly lower than that in the control group,and the difference was statistically significant（P〈0.05）.CHE increased gradually over time after treatment in both groups,and the CHE levels in the observation group at 6,24,36 h after treatment were higher than those in the control group,and the differences were statistically significant（P〈0.05）.After treatment,the levels of TNF-α,IL-1β,IL-6,and IL-8 in the observation group were lower than those in the control group,and the difference was statistically significant（P〈0.05）.Conclusion：PE combined with HP in the treatment of ASOPP has high clinical cure rate,shorter hospitalization time and coma time,lower complication rate and faster recovery of clinical indexes.