血液滤过联合血液灌注在急性重度有机磷农药中毒患者中的应用

Application of Hemofiltration Combined with Hemoperfusion in Patients with Acute Severe Organophosphorus Pesticide Poisoning

目的:探讨急性重度有机磷农药中毒(ASOPP)患者给予连续性静脉-静脉血液滤过(CVVH)联合血液灌注(HP)的应用效果。方法:选取2020年8月至2021年7月平煤神马医疗集团总医院收治的74例ASOPP患者作为研究对象,按照随机数字表法分成观察组37例与对照组37例,对照组给予HP治疗,观察组在对照组基础上联合CVVH治疗,比较两组患者的临床相关指标、炎症因子、生化指标、预后情况、并发症发生率及死亡率。结果:观察组与对照组相比,昏迷时间、胆碱酯酶(ChE)恢复时间、住院时间明显更短,阿托品用量明显更少,差异均具有统计学意义(P<0.05);两组患者治疗7 d后的白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平明显降低,观察组与对照组相比明显更低,差异均具有统计学意义(P<0.05);两组患者治疗7 d后的谷丙转氨酶(ALT)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)水平明显降低,观察组与对照组相比明显更低,差异均具有统计学意义(P<0.05);两组患病治疗7 d后急性生理学和慢性健康状况评价(APACHEⅡ)、序贯器官衰竭估计评分(SOFA)评分明显降低,观察组与对照组相比明显更低,差异均具有统计学意义(P<0.05);观察组的并发症发生率、死亡率均明显低于对照组,差异具均有统计学意义(P<0.05)。结论:ASOPP患者给予CVVH联合HP治疗,相较于单纯HP治疗,能够更有效地改善患者临床相关指标,调节炎症因子及生化指标水平,改善预后情况,降低并发症发生率及死亡率。

Objective To investigate the effect of continuous veno-venous hemofiltration(CVVH)combined with hemperfusion(HP)in acute severe organophosphorus pesticide poisoning(ASOPP).Methods A total of 74 ASOPP patients admitted to General Hospital of Pingmei Medical Group from August 2020 to July 2021 were selected as the research objects.According to random number table method,they were divided into an observation group and a control group,with 37 cases in each group.The control group was given HP treatment,and the observation group was given CVVH treatment on the basis of the control group.Clinical indicators,inflammatory factors,biochemical indicators,prognosis,incidence of complications and mortality were compared between the two groups.Results Compared with the control group,the duration of coma,cholinesterase(ChE)recovery time,hospital stay in the observation group were significantly shorter,and the dosage of atropine was significantly lower,with statistical significances(P<0.05).After 7 d of treatment,the levels of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP)in the two groups were significantly decreased in the observation group,and were significantly lower than those in the control group,the differences were statistically significant(P<0.05).After 7 d of treatment,the levels of alanine aminotransferase(ALT),creatine kinase(CK)and creatine kinase isoenzyme(CK-MB)in the two groups were significantly decreased,and the levels of ALT,CK and CK-MB in the observation group were significantly lower than those in the control group,with statistical significances(P<0.05).After 7 d of treatment,the assessment of acute physiology and acute physiology chronichealth evaluation scoring system Ⅱ(APACHEⅡ)and the sequential organ failure assessment score(SOFA)were significantly decreased,and the scores of APACHE Ⅱ and SOFA in the observation group were significantly lower than those in the control group,with statistical significances(P<0.05).The incidence of complications and mortality in the observation group were significantly lower than those in the control group,with statistical significances(P<0.05).Conclusion Compared with pure HP treatment,CVVH combined with HP treatment in ASOPP patients can more effectively improve the clinical indicators,regulate the levels of inflammatory factors and biochemical indicators,improve the prognosis,and reduce the incidence of complications and mortality.