连续性静脉-静脉血流滤过联合血液灌流治疗急性有机磷中毒的临床疗效观察

Clinical effect of continuous venous-venous hemofiltration combined with hemoperfusion on acute organophosphate poisoning

目的探讨连续性静脉-静脉血流滤过联合血液灌流治疗急性有机磷中毒的临床疗效。方法选择2019年1月至2020年2月在本院确诊的急性有机磷中毒(Acute organophosphorus pesticide poisoning,AOPP)患者80例,根据治疗手段的不同将患者分为观察组和对照组各40例。对照组采用血液灌流治疗,观察组采用连续性静脉-静脉血流滤过治疗,均持续治疗3d。分别于治疗前后检测患者血清心肌损伤相关指标[肌酸激酶同工酶-MB(CK-MB)、脑钠肽(BNP)、肌钙蛋白I(cTnI)]水平以及炎症因子[肿瘤坏死因子-α(INF-α)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)]水平。记录两组患者胆碱酯酶(CHE)活性恢复时间、昏迷时间、机械通气时间、住院时间及救治成功率。结果观察组患者CHE恢复时间、昏迷时间、机械通气时间和住院时间均短于对照组(P<0.05);治疗后,两组患者CK-MB、BNP、cTnI水平均低于治疗前,且观察组低于对照组(P<0.05);治疗后两组患者INF-α、IL-1β、IL-6、IL-8水平均下降,且观察组低于对照组(P<0.05);观察组救治成功率高于对照组(P<0.05)。结论连续性静脉-静脉血流滤过联合血液灌流治疗急性有机磷中毒的临床疗效良好,可以有效清除患者体内有毒物质以及炎症因子,改善患者心功能,减轻心肌损伤,提高患者生存率。

Objective To explore the clinical effect of continuous venous-venous hemofiltration(CVVH)combined with hemoperfusion(HP)on acute organophosphorus pesticide poisoning(AOPP).Methods A total of 80 patients with AOPP admitted in our hospital from January 2019 to February 2020 were selected.According to different treatment methods,they were divided into observation group and control group,with 40 cases in each group.Patients in the control group were treated with HP,the observation group was treated with CVVH.Both groups were continuously treated for 3days.Before and after treatment,levels of serum myocardial injury related indexes[creatine kinase-MB(CK-MB),brain natriuretic peptide(BNP),cardiac troponin I(cTnI)]and inflammatory factors[tumor necrosis factorα(TNF-α),interleukin-1β(IL-1β),interleukin-6(IL-6),interleukin-8(IL-8)]were detected.The recovery time of cholinesterase(CHE)activity,coma time,mechanical ventilation time,hospitalization time and success rate were compared between the two groups.Results The recovery time of CHE,coma time,mechanical ventilation time and hospitalization time in observation group were shorter than those of the control group(P<0.05).After treatment,levels of CK-MB,BNP and cTnI in both groups were decreased,and the levels of the observation group were lower than those of the control group(P<0.05).After treatment,levels of TNF-α,IL-1β,IL-6 and IL-8 in both groups were decreased,and the levels of the observation group were lower than those of the control group(P<0.05).The success rate in observation group was higher than that in control group(P<0.05).Conclusion The clinical curative effect of HP combined with CVVH is good on AOPP.It can effectively eliminate toxic substances and inflammatory factors,improve cardiac function and reduce myocardial damage,which is beneficial to improve survival rate.