胃肠承气洗消溶液联合杂合式血液净化技术对重度有机磷中毒患者血浆细胞因子的影响

Effect of Gastrointestinal Chengqi Washing Solution and Mixed Blood Purification on Plasma Cytokines in Patients with Severe Organic Phosphorus Poisoning

目的观察胃肠承气洗消溶液联合杂合式血液净化技术对重度有机磷中毒患者的治疗效果,并观察其对患者血浆细胞因子的影响。方法患者90例随机分为3组,对照组采用西医常规治疗;治疗1组采用一般治疗联合杂合式血液净化治疗;治疗2组采用一般治疗以及胃肠承气洗消溶液鼻饲联合杂合式血液净化治疗;比较各组患者的临床疗效以及细胞因子水平。结果治疗1组、治疗2组患者胆碱酯酶上升较对照组快,且急性呼吸衰竭的发生率以及中间综合征的发生率较低,入住ICU治疗时间较短,病死率低,且治疗2组疗效优于治疗1组(均P<0.05),但两治疗组患者的病死率的差异无统计学意义(P>0.05)。对照组患者在治疗第10日TNF-α、IL-6、TGF-β1均较治疗前下降(P<0.05);治疗1组与治疗2组患者在治疗12 h后、第5日、第10日后各细胞因子均较治疗前下降(P<0.05),且同一治疗时间治疗1组、治疗2组患者各细胞因子均低于对照组(P<0.05),在治疗第10天,治疗2组各细胞因子水平均低于治疗1组(P<0.05)。结论胃肠承气洗消溶液联合杂合式血液净化技术治疗急性重度有机磷中毒疗效较好,其机制除早期清除毒物以外,还可能与血液净化治疗清除炎症介质,中药胃肠承气洗消溶液抑制减轻炎症反应有关。

Objective:To observe the therapeutic effect of Gastrointestinal Chengqi Washing Solution combined with heterozygous blood purification technology on patients with severe organophosphorus poisoning,and to study its effect on plasma cytokines.Methods:90 patients were randomly divided into three groups,30 cases in each group.The control group adopted general treatment.The first treatment group was treated with general treatment combined with mixed blood purification.The second group was treated with general treatment,nasal feeding Gastrointestinal Chengqi Washing Solution combined with mixed blood purification.The clinical efficacy and cytokine level of the three groups were compared.Results:Cholinesterase increased faster in the first group and the second group than that in the control group.In the first and the second group,the incidence of acute respiratory failure and intermediate syndrome were lower;the time of admission to ICU was shorter,and the mortality was lower.The curative effect of the second group was better than that of the first group(P<0.05).However,there was no significant difference in mortality between them.There was no significant difference in TNF-α,IL-6 and TGF-β1 among the three groups before treatment(P>0.05).All cytokines in the control group decreased on the 10 th day after treatment(P<0.05),and those in the first and second groups decreased on the 12 h,5 th and 10 th day after treatment(P<0.05).The cytokines in the first group and the second group were lower than those in the control group at the same point(P<0.05).On the 10 th day of treatment,the cytokines in the second group were lower than those in the first group(P<0.05).Conclusion:Gastrointestinal Chengqi Washing Solution combined with heterozygous blood purification is effective on acute severe organophosphorus poisoning.The mechanism may be related to the elimination of inflammatory mediators by blood purification treatment and the inhibition of inflammatory response by Gastrointestinal Chengqi Washing Solution to reduce inflammatory reaction,apart from early elimination of poisons.