乌司他丁联合血液灌流和血液透析治疗重度急性有机磷农药中毒患者的疗效分析

Curative effect of ulinastatin combined with hemoperfusion and hemodialysis on patient with severe acute organophosphorus pesticide poisoning

目的:探讨乌司他丁联合血液灌流(HP)和血液透析(HD)与单用乌司他丁对重度急性有机磷农药中毒(AOPP)患者的疗效以及两种治疗方案对患者炎性因子释放、器官功能损伤的影响。方法:采取前瞻性非随机对照研究,选择2012-07—2018-06期间我院急诊内科收治的72例重度AOPP患者作为研究对象,根据患者家属的意愿和病情,将其分为对照组(30例)和观察组(42例)。对照组给予乌司他丁治疗,观察组在对照组的基础上给予HP和HD治疗。比较两组治疗2d后APACHEⅡ评分、阿托品用量、乙酰胆碱酯酶恢复到70%时间、EICU入住时间、昏迷时间、住院时间、治愈率。比较两组治疗前、治疗2d后血肌酐(Cr)、谷丙转氨酶(ALT)、肌酸激酶(CK)水平(干化学法)和活化部分凝血活酶时间(APTT)(血液凝固法)。比较两组治疗前、治疗7d后炎性因子(IL-6、TNF-α和hs-CRP)水平(ELISA检测)。比较两组在院期间的并发症(多器官功能障碍综合征、反跳现象、中间综合征、呼吸衰竭、心律失常、迟发性神经病),并以出院后15d电话随访、中毒后45d门诊复诊方式,明确患者是否出现迟发型神经病症状。结果:观察组治疗2d后APACHEⅡ评分、阿托品用量、乙酰胆碱酯酶恢复到70%时间、EICU入住时间、昏迷时间和住院时间均明显少于对照组(P <0.05)。观察组治疗2d后的APTT、Cr、ALT和CK均明显低于对照组(P<0.05)。观察组治疗7d后的hs-CRP、IL-6和TNF-α水平均明显低于对照组(P<0.05)。观察组多器官功能障碍综合征、反跳现象和中间综合征的发生率明显低于对照组(P<0.05)。两组治愈率比较差异无统计学意义(P>0.05)。结论:HP、HD与乌司他丁联合治疗重度AOPP可提高疗效,减轻重要脏器的损伤程度,同时可降低炎性因子水平和并发症发生率。

Objective：To investigate the influence of the combined use of ulinastatin hemoperfusion（HP）and hemodialysis（HD）and alone use ulinastatin on curative effect of patient with severe acute organophosphorus pesticide poisoning（AOPP）.Method：A prospective,non-randomized,controlled study was used in this study.Patients with severe AOPP were divided into control group and observation group according to the family members of the patient＇s wishes and patient＇s condition.The control group was treated with ulinastatin.The observation group was treated with ulinastatin＋HP＋HD.After 2 days treatment,the APACHE Ⅱscore,atropine dosage,recovery time of acetylcholinesterase to 70%,EICU time,coma time,hospitalization time and cure rate of the two groups were compared.The Cr,ALT,CK and APTT of the two groups were compared before treatment and after 2 days treatment.The concentrations of inflammatory factors（IL-6,TNF-αand hs-CRP）of the two groups were compared before treatment and after 7 days treatment.Complications（MODS,rebound phenomenon,intermediate syndrome,respiratory failure,arrhythmia,delayed neuropathy）of the two groups were analyzed.Follow-up calls were made 15 days after discharge and follow-up visits were conducted 45 days after poisoning to determine whether the patient had delayed neuropathy symptoms.Result：The APACHE II score,atropine dosage,recovery time of acetylcholinesterase to 70%,EICU time,coma time and hospitalization time of the observation group were significantly less than those of the control group（P〈0.05）.The APTT,Cr,ALT and CK concentration of after 2 days treatment in the observation group were significantly lower than those in the control group（P〈0.05）.The concentrations of hsCRP,IL-6 and TNF-αafter 7 days treatment in the observation group were significantly lower than those in the control group（P〈0.05）.The incidence of MODS,rebound phenomenon and intermediate syndrome of the observation group were significantly lower than those in the control group（P〈0.05）.There was no significant difference in the cure rate between the observation group and the control group（P〈0.05）.Conclusion：The combination of HP,HD and ulinastatin in the treatment of severe AOPP can improve the curative effect,relief the degree of damage of important organs,and reduce the concentration of inflammatory factors and the incidence of complications.