多种油脂肪乳辅助治疗对重度急性有机磷农药中毒患者血清胆碱酯酶、肝功能的影响

The effect of multi-oil fat emulsion adjuvant therapy on serum cholinesterase and liver function in patients with severe acute organophosphorus pesticide poisoning

目的探究多种油脂肪乳(SMOF)辅助治疗对重度急性有机磷农药中毒(AOPP)患者血清胆碱酯酶(ChE)、核因子-κB(NF-κB)及肝功能的影响。方法选取2017年6月至2021年6月本院收治的重度急性有机磷农药中毒患者85例,随机分为对照组28例、脂肪乳组31例和SMOF组46例。对照组患者接受常规治疗,脂肪乳组在对照组的基础上,给予中长链脂肪乳治疗(20%脂肪乳静脉滴注),SMOF组给予SMOF混合液静脉滴注,均连续治疗7 d。比较三组临床疗效,不同时间点(入院时,治疗后1、4、7 d)的血清ChE活力、NF-κB及肝功能指标水平。结果各组的昏迷时间、阿托品使用量和EICU入住时间比较,SMOF组<脂肪乳组<对照组(P<0.05),SMOF组和脂肪乳组的病死率均低于对照组(P<0.05)。入院时,各组患者的血清ChE活力、NF-κB和肝功能指标比较,差异无统计学意义(P>0.05);治疗后1、4、7 d,三组的血清ChE活力比较,SMOF组>脂肪乳组>对照组,血清总胆红素、谷丙转氨酶和谷草转氨酶比较,SMOF组<脂肪乳组<对照组(P<0.05);治疗后4、7 d,三组的血清NF-κB水平比较,SMOF组<脂肪乳组<对照组(P<0.05);治疗后1 d,SMOF组和脂肪乳组的血清NF-κB水平低于对照组(P<0.05),但SMOF组和脂肪乳组的血清NF-κB水平比较,差异无统计学意义(P>0.05)。结论SMOF辅助治疗在重度急性有机磷农药中毒患者的临床救治中疗效确切,可有效促进患者ChE活力的恢复,改善血清NF-κB水平,减轻肝脏损伤,在促进患者恢复的同时,减少病死率。

Objective To explore the effect of multi-oil fat emulsion including soybean oil,medium-chain triglycerides,olive oil and fish oil(SMOF)adjuvant therapy on serum cholinesterase(ChE),nuclear factor-κB(NF-κB)and liver function in patients with severe acute organophosphorus pesticide poisoning(AOPP).Methods A total of 85 patients with severe AOPP admitted to our hospital between June 2017 and June 2021 were selected.The patients were randomly divided into a control group(n=28),a fat emulsion group(n=31)and a SMOF group(n=46).The control group was given conventional treatment.On this basis,the fat emulsion group was treated with medium and long chain fat emulsion(intravenous drip of 20%fat emulsion)and the SMOF group was treated with SMOF(intravenous drip of SMOF mixture)for 7 days.The clinical effects,serum ChE activity,NF-κB,and liver function indicators on admission,after 1 day,4 and 7 days of treatment were compared among the groups.Results Comparison of coma time,atropine usage,and stay time in emergency intensive care unit(EICU)among the groups showed that the SMOF group<the fat emulsion group<the control group(P<0.05).The fatality rates in the SMOF group and the fat emulsion group were lower than that in the control group(P<0.05).There was no significant difference in serum ChE activity,NF-κB and liver function indicators among the three groups at admission(P>0.05).After 1 day,4 and 7 days of treatment,serum ChE activity in the SMOF group was higher than that in the fat emulsion group and the control group(P<0.05).The levels of serum total bilirubin,alanine aminotransferase and aspartate aminotransferase were increased in order from the SMOF group,the fat emulsion group to the control group(P<0.05).Serum NF-κB level after 4 and 7 days of treatment was increased in order from the SMOF group,the fat emulsion group to the control group(P<0.05).Serum NF-κB levels in the SMOF group and the fat emulsion group after 1 day of treatment were lower than that in the control group(P<0.05).However,there was no significant difference between the SMOF group and the fat emulsion group(P>0.05).Conclusion SMOF adjuvant therapy is effective in the clinical treatment of patients with severe AOPP.It can effectively promote the recovery of ChE vitality,improve the serum NF-κB level,and reduce the liver damage.It promotes the recovery of patients while reducing the mortality rate.