连续性床旁血液滤过对急性有机磷农药中毒患者血清脂蛋白(a)胆碱酯酶活力及心功能指标的影响

Effect of Continuous Bedside Hemofiltration on Serum Lipoprotein(a)Cholinesterase Activity and Cardiac Function Indexes in Patients with Acute Organophosphorus Pesticide Poisoning

目的:探究连续性床旁血液滤过治疗对急性有机磷农药中毒(AOPP)患者血清脂蛋白(a)[Lp(a)]、胆碱酯酶(ChE)活力和心功能指标的影响。方法:选取2016年5月至2020年5月本院收治的AOPP患者160例,简单随机法分为观察组(n=86)和对照组(n=74)。对照组给予常规对症治疗,观察组在对照组的基础上给予连续性床旁血液滤过治疗,比较两组患者的临床疗效,不同时间点的血清Lp(a)水平、ChE活力和心功能指标的变化。结果:观察组患者的昏迷时间、机械通气时间/住院时间和血清ChE活力恢复时间均短于对照组,阿托品使用量小于对照组,病死率低于对照组(P<0.05);治疗后,两组患者的血清Lp(a)、ChE活力及心功能指标均随治疗时间的增加呈不同程度的升高或降低,且治疗后24h、48h和72h,观察组的血清Lp(a)水平低于对照组,左室射血分数(LVEF)水平高于对照组(P<0.05),治疗后48h和72h,观察组的血清ChE活力高于对照组,左室收缩末期内径(LVIDs)和B型脑钠肽(BNP)水平均低于对照组(P<0.05)。结论:连续性床旁血液滤过在治疗AOPP方面疗效确切,可有效改善患者的血清Lp(a)水平和ChE活力,减轻患者心肌损伤并促进心功能恢复。

Objective:To explore the effect of continuous bedside hemofiltration on serum lipoprotein(a)[Lp(a)],cholinesterase(ChE)activity and cardiac function indexes in patients with acute organophosphorus pesticide poisoning(AOPP).Methods:A total of 160 patients with AOPP admitted to the hospital from May 2016 to May 2020 were selected and randomly divided into observation group(n=86)and control group(n=74).The control group received conventional symptomatic treatment,and on this basis,the observation group received continuous bedside hemofiltration.The clinical effects,changes in serum Lp(a)level,ChE activity and cardiac function indexes at different time points were compared between the two groups.Results:The coma duration,mechanical ventilation time/hospital stay and serum ChE activity recovery time of the observation group were shorter than those of the control group.The dosage of atropine was lower than that in the control group,and the mortality rate was lower than that in the control group(P<0.05).After treatment,serum Lp(a),ChE activity and cardiac function indexes in the two groups changed over time to varying degrees.24h,48h and 72h after treatment,the observation group had lower serum Lp(a)levels and higher left ventricular ejection fraction(LVEF)than the control group(P<0.05).48h and 72h after treatment,serum ChE activity in the observation group was higher than that in the control group,and the left ventricular end systolic diameter(LVIDs)and B-type natriuretic peptide(BNP)levels were lower than those in the control group(P<0.05).24h after treatment,there were no significant differences in serum ChE activity,LVIDs and BNP levels between the two groups(P>0.05).Conclusion:Continuous bedside hemofiltration is effective in the treatment of AOPP.It can effectively improve the patients’serum Lp(a)level and ChE activity,reduce myocardial damage and promote cardiac function recovery.