单次血液灌流后联合应用血必净和碘解磷定治疗老年急性有机磷中毒的临床分析

Clinical analysis of Xuebijing combined with pralidoxime iodide in the treatment of elderly patients with acute organophosphorus poisoning after a single hemoperfusion

目的观察单次血液灌流后应用血必净联合碘解磷定治疗老年急性有机磷中毒患者的疗效,为治疗该病提供方法。方法选取2018年1月—2021年6月安徽医科大学附属阜阳市人民医院收治的老年急性有机磷中毒患者60例,按照数字表法随机分为观察组和对照组,每组30例。2组均接受洗胃、利尿、导泻、维持水电解质及酸碱平衡干预治疗,基于以上基础治疗,对照组接受血必净和碘解磷定治疗,观察组行单次血液灌流,灌流后增加与对照组相同的血必净和碘解磷定治疗。观察并比较2组治疗前后血常规参数值、心肌酶谱值、肝功能指标值、胆碱酯酶(ChE)值和炎症反应指标水平;观察并比较2组ChE复常时间、清醒时间、中毒症状消失时间、阿托品化时间和使用总量、呼吸衰竭发生率、病死率及临床疗效。结果治疗后,2组血常规参数值、心肌酶谱值、肝功能指标值和炎症反应指标水平均明显低于同组治疗前(P<0.05),而观察组上述检测值降幅均明显大于对照组(P<0.05);2组ChE水平均明显高于同组治疗前(P<0.05),且观察组升幅大于对照组(P<0.05);观察组患者ChE复常时间、清醒时间、中毒症状消失时间和阿托品化时间均明显少于对照组(P<0.05),阿托品使用总量显著低于对照组(P<0.05)。观察组治疗总有效率明显高于对照组(P<0.05)。结论单次血液灌流后联合应用血必净和碘解磷定治疗老年急性有机磷中毒,效果理想,可修复患者心脏和肝脏损伤,抑制炎症反应,改善心肌酶异常变化,具有一定的临床应用价值。

Objective To observe the curative effects of Xuebijing combined with pralidoxime iodide in the treatment of elderly patients with acute organophosphorus poisoning after a single hemoperfusion,so as to provide a method for the treatment of the disease.Methods 60elderly patients with acute organophosphorus poisoning admitted to Fuyang People’s Hospital Affiliated to Anhui Medical University from January2018to June2021were selected and divided into control group and observation group according to the number table method,with30cases in each group.Both groups received the basic treatments,such as gastric lavage,diuresis,catharsis,maintenance of water-electrolyte and acid-base balance.Based on the above basic treatments,the control group was treated with Xuebijing combined with pralidoxime iodide.The observation group received a single hemoperfusion and the same treatment as the control group(Xuebijing combined with pralidoxime iodide)after the hemoperfusion.The blood routine parameter values,myocardial zymogram values,liver function index values,cholinesterase(ChE)values and inflammatory reaction index level were observed and compared between the two groups before and after treatment.The ChE normalization time,waking time,disappearance time of toxic symptoms,time to atropineization and total amount of atropine used,incidence of respiratory failure,mortality and clinical efficacy were observed and compared between the two groups.Results After treatment,the blood routine parameter value,myocardial enzyme spectrum value,liver function index value and inflammatory reaction index level of the two groups were significantly lower than those of the same group before treatment(P<0.05),while the decrease of the above detection values of the observation group was significantly greater than those of the control group(P<0.05);the level of ChE of both groups was significantly higher than that of the same group before treatment(P<0.05),and the increase of the observation group was greater than that of the control group(P<0.05).The ChE normalization time,waking time,disappearance time of toxic symptoms,time to atropineization of the observation group were significantly shorter than those of the control group(P<0.05),and the total amount of atropine used was significantly lower than that of the control group(P<0.05).The total effective rate of treatment of the observation group was significantly higher than that of the control group(P<0.05).Conclusion After a single hemoperfusion,the combined application of Xuebijing and pralidoxime iodide in the treatment of elderly patients with acute organophosphorus poisoning has an ideal effect.It can repair the heart and liver damage of patients,inhibit inflammatory reaction,and improve the abnormal changes of myocardial enzymes.It has a certain clinical application value.