山莨菪碱联合碘解磷定对急性有机磷农药中毒患者乳酸、NF-κB及内皮功能的影响

Effects of anisodamine combined with chlorophosphoridine on lactic acid,NF-κB and endothelial function in patients with acute organophosphorus pesticide poisoning

目的观察山莨菪碱联合碘解磷定对急性有机磷农药中毒患者乳酸、核因子活化B细胞κ轻链增强子(NF-κB)的影响。方法选择2009年2月—2017年3月新疆医科大学第一附属医院急救·创伤中心急诊内科收治的急性有机磷农药中毒患者128例作为研究对象,随机数字表法分为对照组和观察组各64例。2组患者均给予常规治疗,对照组患者另予碘解磷定治疗,观察组另加山莨菪碱联合碘解磷定治疗。比较2组患者临床疗效,检测治疗前后血清乳酸、NF-κB、内皮功能指标及血清胆碱酯酶水平变化,比较不良反应发生率。结果观察组患者临床治疗总有效率明显高于对照组(96.88%vs.81.25%,χ^2/P=8.020/0.005)。与治疗前比较,2组患者血清NO明显升高,乳酸、NF-κB及ET-1明显降低,且观察组改善程度较对照组更显著(t/P=12.546/0.000,10.710/0.000,14.409/0.000,22.916/0.000)。治疗后,2组血清胆碱酯酶水平逐渐升高,且观察组患者在各个时间点均高于对照组(t/P=15.760/0.000,13.061/0.000,5.637/0.000)。结论山莨菪碱联合碘解磷定治疗急性有机磷农药中毒患者,可以有效降低其血清乳酸、NF-κB水平,升高胆碱酯酶水平,改善机体内皮功能,疗效显著。

Objective To observe the effect of anisodamine combined with chlorophosphoridine on lactic acid and nuclear factor activated B cell kappa light chain enhancer(NF-κB)in patients with acute organophosphorus pesticide poisoning.Methods One hundred and twenty-eight patients with acute organophosphorus pesticide poisoning admitted to the emergency department of the First Affiliated Hospital of Xinjiang Medical University from February 2009 to March 2017 were selected as the research objects.They were randomly divided into control group and observation group with 64 cases in each group.Two groups of patients were given conventional treatment,the control group was given iodophosphatidine treatment,the observation group was added anisodamine combined with iodophosphatidine treatment.The clinical efficacy was compared between the two groups.The changes of serum lactic acid,NF-κB,endothelial function and serum cholinesterase levels were detected before and after treatment,and the incidence of adverse reactions was compared.Results The total effective rate of the observation group was significantly higher than that of the control group(96.88%vs.81.25%,χ^2/P=8.020/0.005).Compared with before treatment,serum NO was significantly increased,lactate,NF-κB and ET-1 were significantly decreased in the two groups,and the improvement of the observation group was more significant than that of the control group(t/P=12.546/0.000,10.710/0.000,14.409/0.000,22.916/0.000).After treatment,the serum cholinesterase level of the two groups increased gradually,and the observation group was higher than the control group at all time points(t/P=15.760/0.000,13.061/0.000,5.637/0.000).Conclusion Anisodamine combined with pralidoxime in the treatment of acute organophosphorus pesticide poisoning patients,can effectively reduce the serum lactic acid,NF-κB levels,increase the level of cholinesterase,improve the body endothelial function,the curative effect is significant.