还原型谷胱甘肽联合盐酸戊乙奎醚治疗重度急性有机磷农药中毒患者的效果

Effects of reduced glutathione combined with Penehyclidine hydrochloride in treatment of patients with severe acute organophosphorus pesticide poisoning

目的:观察还原型谷胱甘肽联合盐酸戊乙奎醚治疗重度有机磷农药中毒(AOPP)患者的效果。方法:回顾性分析2020年6月至2023年6月该院收治的60例重度AOPP患者的临床资料,按照治疗方法不同将其分为对照组和观察组各30例。两组均予以急救治疗,在此基础上,对照组予以盐酸戊乙奎醚治疗,观察组在对照组基础上联合还原型谷胱甘肽治疗,两组均持续治疗7 d。比较两组临床疗效,治疗前后肝功能指标[天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)]水平、心肌酶指标[肌酸激酶(CK)、乳酸脱氢酶(LDH)、肌酸激酶同工酶(CK-MB)]水平、血清胆碱酯酶(ChE)水平、氧化应激指标[脂质过氧化物(LPO)、丙二醛(MDA)、对氧磷酶1(PON1)]水平,以及不良反应发生率。结果:观察组治疗总有效率为86.67%(26/30),高于对照组的63.33%(19/30),差异有统计学意义(P<0.05);治疗后,观察组AST、ALT、TBIL、CK-MB、LDH、CK、LPO、MDA水平均低于对照组,PON1水平高于对照组,差异有统计学意义(P<0.05);治疗1、4、7 d后,观察组血清ChE水平均高于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:还原型谷胱甘肽联合盐酸戊乙奎醚治疗重度AOPP患者可提高治疗总有效率和血清ChE水平,降低肝功能指标和心肌酶指标水平,改善氧化应激指标水平,效果优于单纯盐酸戊乙奎醚治疗。

Objective:To observe effects of reduced glutathione combined with Penehyclidine hydrochloride in treatment of patients with severe acute organophosphorus pesticide poisoning(AOPP).Methods:The clinical data of 60 patients with severe AOPP admitted to this hospital from June 2020 to June 2023 were retrospectively analyzed.According to different treatment methods,they were divided into control group and observation group,30 cases in each.Both groups were given emergency treatment.On this basis,the control group was treated with Penehyclidine hydrochloride,while the observation group was treated with reduced glutathione on the basis of that of the control group.Both groups were treated for 7 d.The clinical efficacy,the liver function indexes[aspartate aminotransferase(AST),alanine aminotransferase(ALT),total bilirubin(TBIL)]levels,the myocardial enzyme indexes[creatine kinase(CK),lactate dehydrogenase(LDH),creatine kinase isoenzyme(CK-MB)]levels,the serum cholinesterase(ChE)level,the oxidative stress indexes[lipid peroxide(LPO),malondialdehyde(MDA),paraoxonase 1(PON1)]levels,and incidence of adverse reactions were compared between the two groups before and after the treatment.Results:The total effective rate of the observation group was 86.67%(26/30),which was higher than 63.33%(19/30)of the control group,and the difference was statistically significant(P<0.05).After the treatment,the levels of AST,ALT,TBIL,CK-MB,LDH,CK,LPO and MDA in the observation group were lower than those in the control group,the level of PON1 in the observation group was higher than those in the control group,and the differences were statistically significant(P<0.05).After 1,4 and 7 days of treatment,the levels of serum ChE in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).However,there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions:Reduced glutathione combined with Penehyclidine hydrochloride in the treatment of the patients with severe AOPP can improve the total effective rate of treatment and the serum ChE levels,reduce the levels of liver function indexes and myocardial enzyme indexes,and improve the levels of oxidative stress indexes.Moreover,it is superior to single Penehyclidine hydrochloride treatment.