序贯性血液净化用于治疗急性有机磷农药中毒并发MODS对患者氧化应激水平和免疫功能的影响

Effect of sequential blood purification on oxidative stress level and im­mune function in patients with acute organophosphorus pesticide poi­soning

目的 分析序贯性血液净化用于急性有机磷农药中毒并发多器官功能障碍综合征(multiple organ dysfunc?tion syndrome,MODS)对患者体内氧化应激、免疫功能指标的变化影响.方法 选取上海市第一人民医院2014年8月—2019年4月收治的急性有机磷农药中毒并发MODS患者70例,分为两组.对照组给予常规治疗,观察组加用序贯性血液净化治疗,记录机械通气时间、胆碱脂酶恢复时间、阿托品用量、住院时间.在入院时、治疗72 h后采集外周血样本检测超氧化物歧化酶(superoxide dismutase,SOD)、丙二醛(Malonaldehyde,MDA)的水平,在入院时及治疗后1周采集外周血标本,检测CD3+、CD4+、CD4+/CD8+的含量.结果 观察组机械通气时间(29.42±6.25)h、血胆碱酯酶(Blood cholinesterase,ChE)恢复正常时间(4.85±1.03)d、住院时间(10.14±1.84)d短于对照组[(45.13±8.05)h、(8.96±1.25)d、(15.95±2.54)d],阿托品用量(174.32±17.45)mg少于对照组(278.36±28.36)mg(P<0.05).两组治疗前氧化应激、免疫功能水平组间比较,差异不具有统计学意义(P>0.05).观察组治疗后SOD、CD3+、CD4+、CD4+/CD8+分别为(99.36±9.85)U/mL、(64.21±11.24)%、(37.96±7.96)%、(1.54±0.42)%,均高于对照组[(82.41±8.44)U/mL、(55.36±10.79)%、(34.57±8.11)%、(1.37±0.41)%],MDA(3.86±0.98)μmol/L水平低于对照组(5.98±1.25)μmol/L(P<0.05).观察组治愈率(94.29%)高于对照组(77.14%),差异具有统计学意义(P<0.05).结论 序贯性血液净化用于治疗急性有机磷农药中毒并发MODS可改善免疫功能和氧化应激功能紊乱情况,缩短机械通气时间、促进的ChE恢复,提高治愈率.

Objective To analyze the effects of sequential blood purification on oxidative stress and immune function in patients with acute organophosphorus pesticide poisoning complicated with multiple organ dysfunction syndrome(MODS).Methods 70 patients with acute organophosphorus pesticide poisoning complicated with MODS were random­Ly divided into two groups:The control group was given routine treatment,the observation group was treated with se­quential blood purification,the mechanical ventilation time,cholinesterase recovery time,atropine dosage and hospital­ization time were recorded.The levels of Superoxide dismutase,SOD and Malonaldehyde,MDA in peripheral blood were measured 72 hours after admission,and the contents of CD3,CD4 and CD4/CD8 were measured at admission and I week after treatment.Results The time of mechanical ventilation in the observation group was(29.42±6.25)h,the re­covery time of serum cholinesterase(Blood cholinesterase,ChE)was(4.85±1.03)days,and the hospitalization time was(10.14±1.84)days,which was shorter than that in the control group[(45.13±8.05)h,(8.96±1.25)d,(15.95±2.54)d],and the dosage of atropine(174.32±17.45)mg was less than that in the control group(278.36±28.36)mg(P<0.05).There was no statistically significant difference between the two groups of pretherapeutic oxidative stress and immune function(P&gt;0.05).After the observation group treatment,SOD,CD3+,CD4+,CD4+/CD8+ were(99.36±9.85)U/mL,(64.21±11.24)%,(37.96±7.96)%,(1.54±0.42)%,respectively.,higher than the control group[(82.41±8.44)U/mL,(55.36±10.79)%,(34.57±8.11)%,(1.37±0.41)%],MDA(3.86±0.98)μmol/L level is lower than that of the control group(5.98±1.25)μmol/L healing rate of the observation group(94.29%)was higher than that of the control group(77.14%),and the difference was statistically significant(P&It;0.05).Conclusion Sequential blood purifica­tion can improve immune function and oxidative stress disorder,shorten mechanical ventilation time,promote ChE re­covery and improve cure rate in the treatment of acute organophosphorus pesticide poisoning complicated with MODS.