脂肪乳序贯血液灌流对急性重度有机磷中毒患者胆碱酯酶活力 阿托品使用量及氧合指数的影响

Effects of sequential hemoperfusion of fat emulsion on cholinesterase activity,Atropine dosage and oxygenation index in patients with acute severe organophosphorus poisoning

目的探究脂肪乳序贯血液灌流对急性重度有机磷中毒(ASOP)患者胆碱酯酶活力、阿托品使用量及氧合指数的影响。方法选取我院2018年8月至2020年10月期间105例ASOP患者作为研究对象,依据治疗方案的不同分为对照组和观察组。对照组52例给予洗胃、导泻、阿托品、氯解磷定、抗感染、呼吸支持及血液灌流等综合治疗,观察组53例在对照组基础上于血液灌流前给予脂肪乳静脉滴注,对比2组患者临床疗效,胆碱酯酶活力,阿托品使用情况,动脉血气指标及氧合指数。结果观察组抢救成功率98%(52/53)高于对照组96%(50/52),差异无统计学意义(P>0.05);观察组治愈好转率96%(51/53)高于对照组81%(42/52),差异有统计学意义(P<0.05)。2组患者治疗前至治疗第7天胆碱酯酶活力水平呈逐渐升高趋势,且观察组高于对照组(P<0.05)。观察组阿托品使用总量、阿托品化时间水平均低于对照组(P<0.05)。2组患者治疗3 d末pH、HCO3-、氧合指数水平较治疗前均升高,且观察组高于对照组(P<0.05)。结论脂肪乳序贯血液灌流治疗ASOP患者,通过抑制乙酰胆碱积聚,调节动脉血气指标及氧合指数,改善恶心、多汗、心率减慢等临床症状,改善阿托品使用情况,调控胆碱酯酶活力水平,提高临床疗效。

Objective To investigate the effects of sequential hemoperfusion of fat emulsion on cholinesterase activity,Atropine dosage and oxygenation index in the patients with acute severe organophosphorus poisoning(ASOP).Methods A total of 105 ASOP patients admitted to our hospital between August 2018 and October 2020 were included as the subjects in the study.According to different treatment protocols methods,all patients were divided into the control group and study group.The control group(n=52)was given comprehensive treatments such as gastric lavage,catharsis,Atropine,Pralidoxime chloride,anti-infection,respiratory support and hemoperfusion.In addition,the study group(n=53)was given intravenous irrigation of fat emulsion before hemoperfusion.The clinical efficacy,cholinesterase activity,Atropine dosage,arterial blood gas index and oxygenation index were compared between the two groups.Results The success rate of first aid in the study group was higher than that in the control group[98%(52/53)vs 96%(50/52)],and there was no difference(P>0.05).The recovery rate in the study group was higher than that in the control group[96%(51/53)vs 81%(42/52),P<0.05].The cholinesterase activity level in the groups showed a gradually increasing trend at baseline to the 7d after treatment,and the level in the study group was higher than that in the control group(P<0.05).The total dosage of Atropine and the Atropine dosage during atropineization in the study group were lower than those in the control group(both P<0.05).The levels of pH,HCO3-and oxygenation index in the two groups at the end of 3d after treatment were higher than those at baseline,and the levels in the study group were higher than those in the control group(all P<0.05).Conclusion In the treatment of ASOP patients,sequential hemoperfusion of fat emulsion may inhibit acetylcholine accumulation,regulate arterial blood gas index and oxygenation index to improve clinical symptoms(such as nausea,hyperhidrosis and slow heartbeat)and use of Atropine,to regulate cholinesterase activity level,and thereby to improve clinical efficacy.