不同方式血液净化对急性有机磷中毒患者心肌保护作用的影响

Effects of different blood purification methods on myocardial protection in patients with acute organophosphorus poisoning

目的探讨血液灌流联合高通量血液透析对急性有机磷中毒患者心肌保护作用的影响。方法选取我院收治的82例急性有机磷中毒患者,随机分为对照组和观察组,每组各41例。对照组进行血液灌流治疗及护理,观察组进行序贯血液净化(血液灌流联合高通量血液透析)治疗及护理。比较两组临床疗效总有效率、血清肌钙蛋白I(cTnI)、肌酸激酶(CK)、乳酸脱氢酶(LDH)、肌酸激酶同工酶(CK-MB)、血清神经元特异性烯醇化酶(NSE)、胆碱酯酶(CHE)活力及护理满意度、救治成功率和死亡率。结果观察组临床疗效总有效率明显高于对照组,差异有统计学意义(P<0.05)。干预后,两组cTnI、CK、LDH、CK-MB活力明显低于干预前,且观察组明显低于对照组,差异有统计学意义(P<0.05)。观察组CHE活力明显高于干预前,NSE活力明显低于干预前,且CHE活力明显高于对照组,NSE活力明显低于对照组,差异均有统计学意义(P<0.05)。观察组护理满意度、救治成功率明显高于对照组;死亡率明显低于对照组,差异有统计学意义(P<0.05)。结论急性有机磷中毒患者采用序贯血液净化治疗及护理,改善了心肌、神经组织损伤,提高了救治成功率和护理满意度。

Objective To investigate the effect of hemoperfusion combined with high-flux hemodialysis on myocardial protection in patients with acute organophosphorus poisoning.Methods 82 cases of acute organophosphate poisoning patients from a hospital were randomly divided into control group and observation group,each group of 41 cases. The control group received hemoperfusion treatment and nursing,while the observation group received sequential blood purification(hemoperfusion combined with high-throughput hemodialysis)treatment and nursing. The total effective rate,serum troponin I(cTnI),creatine kinase(CK),lactate dehydrogenase(LDH),creatine kinase isoenzyme(CK-MB),serum neuron-specific enolase(NSE),cholinesterase(CHE)activity,nursing satisfaction,treatment success rate and mortality rate were compared between the two groups. Results The total effective rate of the observation group was significantly higher than that of the control group,and the difference was statistically significant(P<0.05). After the intervention,the activity of cTnI,CK,LDH and CK-MB in the two groups was significantly lower than that before the intervention,and the observation group was significantly lower than the control group,with statistically significant differences(P<0.05). In the observation group,CHE activity was significantly higher than that before intervention,NSE activity was significantly lower than that before intervention,CHE activity was significantly higher than that of the control group,and NSE activity was significantly lower than that of the control group,with statistically significant differences(P<0.05). Nursing satisfaction and treatment success rate in the observation group were significantly higher than those in the control group. The mortality rate was significantly lower than that of the control group,and the difference was statistically significant(P<0.05). Conclusions Treatment by sequential blood purification combining with nursing care for patients with acute organophosphorus poisoning can improve the myocardial and nerve tissue injury,and enhance the success rate of treatment and nursing satisfaction.