高强度血液灌流联合早期长时程持续肾脏替代疗法治疗重度有机磷中毒的临床应用

High-intensity hemoperfusion combined with early long-term CRRT for severe organophosphorus poisoning

目的探讨重度有机磷中毒患者应用高强度血液灌流联合持续肾脏替代疗法（CRRT）治疗后的效果。方法采用随机数字表法将89例重度有机磷中毒患者分为两组，对照组44例给予常规血流灌注联合CRRT治疗，观察组45例采用高强度血液灌流联合CRRT治疗。比较两组患者治疗后胆碱酯酶活力、药物使用量、机械通气时间、住院时间、并发症发生率及病死率。结果观察组治疗后3、5 d胆碱酯酶活力均高于对照组，长托宁、阿托品、氯解磷定使用量及机械通气时间与住院时间均低于对照组（P均〈0.05）；观察组并发症发生率（15.56%）、病死率（6.67%）均低于对照组（43.18%、27.27%），差异有统计学意义（P〈0.05）。结论高强度血液灌流联合CRRT能够显著提升重度有机磷中毒患者的胆碱酯酶活力，常规药物使用量少，利于早期去除呼吸机，安全性高，住院时间少，病死率低。

Objective To investigate the effect of high intensity hemoperfusion combined with continuous renal replacement therapy （CRRT） on patients with severe organophosphorus poisoning. Methods Random number table method was used to divide the 89 patients with severe organophosphorus poisoning into two groups, 44 cases in the control group were given routine perfusion combined with CRRT treatment, and 45 cases in the observation group were given high intensity of hemoperfusion com- bined with CRRT treatment. The eholinesterase activity, drug use, mechanical ventilation time, hospital- ization time, incidence of complications and fatality rate after treatment in the two groups were compared. Results On the 3rd and 5th day after treatment, the cholinesterase activity in the observation group was higher than that in the control group, the dosage of penehyclidine hydrochloride, atropine, and pralid- oxime chloride, mechanical ventilation time and hospital stay were lower than those of the control group （P〈0.05） ; in the observation group, the complication rate （15.56%）, fatality rate （6.67%） were lower than those in the control group （43.18% , 27.27% ）, the differences between the two groups were significant （P 〈 0. 05 ）. Conclusions The high intensity hemoperfusion combined with CRRT can sig- nificantly improve the activity of cholinesterase in patients with severe organophosphorus poisoning. The amount of conventional drugs is less, which is conducive to early removal of respirator, and has higher safety, less hospitalization time and lower mortality.