血液灌流联合阿托品治疗有机磷农药中毒临床疗效研究

Clinical effect of hemoperfusion combined with atropine in treating organophosphorus pesticide poisoning

目的探讨血液灌流联合阿托品治疗有机磷农药中毒的临床疗效。方法选取自2013年1月至2017年12月收治的急性有机磷农药中毒患者64例,患者均行洗胃、导泻、药用活性炭吸附等方式进行消化道清洗的常规治疗。其中,A组患者给予阿托品治疗(n=32),B组患者给予阿托品联合血液灌流治疗(n=32)。记录并比较两组患者临床疗效、意识恢复时间、阿托品用量、住院时间、并发症情况、病死率,以及治疗前与治疗后3、7d肌酸激酶同工酶、胆碱酯酶、心肌肌钙蛋白I水平。结果B组患者总有效率为93.8%(30/32),显著高于A组的75.0%(24/32),差异有统计学意义(P<0.05)。A组患者病死率为12.5%(4/32),B组患者病死率为6.3%(2/32),差异无统计学意义(P>0.05)。B组患者意识恢复时间、住院时间明显短于A组,且阿托品用量少于A组,差异均有统计学意义(P<0.05)。B组患者迟发性神经损害、中间综合征、中毒性肝损害及反跳的发生率均明显低于A组,差异有统计学意义(P<0.05)。B组患者胆碱酯酶恢复时间明显短于A组;治疗后,两组患者胆碱酯酶活性均较入院时升高,且B组高于A组,差异均有统计学意义(P<0.05)。治疗后,两组患者肌酸激酶同工酶、心肌肌钙蛋白I水平均较入院时明显降低,且B组低于A组,差异均有统计学意义(P<0.05)。结论血液灌流联合阿托品治疗有机磷农药中毒疗效显著,可明显降低并发症的发生率。

Objective To investigate the effect of hemoperfusion combined with atropine on organophosphorus pesticide poisoning. Methods A retrospective study was performed on 64 cases of patients with acute organophosphorus pesticide poisoning who were admitted from January 2013 to December 2017.All the patients received routine treatment of digestive tract cleaning by gastric lavage,catharsis and active carbon adsorption.Patients in Group A were treated with atropine( n =32),while patients in Group B were treated with atropine combined with hemoperfusion( n =32).Clinical efficacy,time of consciousness recovery,atropine dosage,length of stay,complications,mortality,and levels of creatine kinase isoenzyme,cholinesterase and cardiac troponin I before and 3 days,7 days after treatment were recorded and compared in the two groups. Results The total effective rate of Group B was 93.8%(30/32),significantly higher than 75.0%(24/32)of Group A,and the difference was statistically significant( P <0.05).The fatality rate was 12.5%(4/32)in Group A and 6.3%(2/32)in Group B,with no statistically significant difference( P >0.05).The recovery time and hospitalization time of patients in Group B were significantly shorter than those in Group A,and the atropine dosage was less than that in Group A( P <0.05).The incidence of delayed nerve injury,intermediate syndrome,toxic liver injury and rebound in Group B was significantly lower than that in Group A( P <0.05).The recovery time of cholinesterase in Group B was significantly shorter than that in Group A.After treatment,the activity of cholinesterase was increased in both groups compared with that at admission,and in Group B was higher than that in Group A( P <0.05).After treatment,the levels of creatine kinase isoenzyme and cardiac troponin I in both groups were significantly lower than those at admission,and the level of Group B was lower than that of Group A( P <0.05). Conclusion The efficacy of hemoperfusion combined with atropine in the treatment of organophosphorus pesticide poisoning is significant,and the complications are significantly reduced.