急诊床旁血液灌流治疗老年镇静催眠类药物中毒的疗效

Efficacy of bedside hemoperfusion in emergency department for sedative and hypnotic drug poisoning in the elderly

目的:探究急诊床旁血液灌流治疗老年镇静催眠类药物中毒患者的临床效果。方法:选取2017年1月—2020年4月期间我院112例老年镇静催眠类药物中毒患者的临床资料进行回顾性分析,根据治疗方案不同分为研究组与对照组,各56例。两组入院后均给予基础干预,于此基础上,对照组采取盐酸纳洛酮及清开灵注射液治疗,研究组在对照组基础上加用急诊床旁血液灌流。比较两组治疗效果、并发症发生率、意识清醒时间及住院时间、治疗前后血浆药物浓度、血气状态指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO^(2))、平均动脉压(MAP)、pH值]、炎性因子(IL-6、IL-8、TNF-α)水平。结果:研究组总有效率(92.86%)高于对照组(78.57%),差异有统计学意义(P<0.05);研究组意识清醒时间及住院时间短于对照组(P<0.05);研究组治疗后15、30、60、120、720min时血浆药物浓度低于对照组(P<0.05);研究组治疗后PaO_(2)、MAP高于对照组,PaCO_(2)、pH值低于对照组(P<0.05);研究组治疗后血清IL-6、IL-8、TNF-α水平低于对照组(P<0.05);研究组并发症发生率(3.57%)低于对照组(14.29%),差异有统计学意义(P<0.05)。结论:急诊床旁血液灌流配合常规药物治疗能进一步降低老年镇静催眠类药物中毒患者血浆药物浓度,有效改善血气状态,降低血清炎性因子水平,促进患者恢复,疗效显著,安全性高。

Objective:To explore the clinical effect of emergency bedside hemoperfusion in the treatment of elderly patients with sedative and hypnotic drug poisoning.Methods:The clinical data of 112elderly patients with sedative and hypnotic drug poisoning in our hospital from January 2017to April 2020were selected for retrospective analysis.According to different treatment plans,they were divided into study group and control group.56cases were in each group.Both groups were given basic intervention after admission.On this basis,the control group was treated with naloxone hydrochloride and Qingkailing injection,and the study group was given perfusion of emergency bedside blood on the basis of the control group.The treatment effect,incidence of complications,time of consciousness and hospitalization,plasma drug concentration and blood gas state indicators[arterial blood oxygen partial pressure(PaO_(2)),arterial blood carbon dioxide partial pressure(PaCO_(2)),mean arterial pressure(MAP),pH value],and inflammatory factor levels(IL-6,IL-8,TNF-α)before and after treatment were compared between the two groups.Results:The total effective rate in the study group(92.86%)was higher than that in the control group(78.57%)(P<0.05);the time for consciousness and hospitalization in the study group was shorter than that in the control group(P<0.05);the plasma drug concentration in the study group was lower than that in the control group at 15min,30min,60min,120min,and 720min(P<0.05);PaO_(2)and MAP in the study group were higher than those in the control group after treatment,and the values of PaCO_(2)and pH were lower than the control group(P<0.05);the levels of serum IL-6,IL-8,and TNF-αin the study group were lower than those in the control group(P<0.05);the incidence of complications in the study group(3.57%)was lower than that in the control group(14.29%)(P<0.05).Conclusion:Emergency bedside blood perfusion combined with conventional drug treatment can further reduce the plasma drug concentration in elderly patients with sedative hypnotic poisoning and effectively improve the blood gas state,reduce the level of serum inflammatory factors,and promote the recovery of patients.It has obvious curative effect and high safety.