规范化急救配合早期杂合式血液净化对急性有机磷中毒救治效果

The effect of standardized emergency treatment combined with early hybrid blood purification on the treatment of acute organophosphorus poisoning

目的探讨规范化急救联合杂合式血液净化在急性有机磷中毒(AOPP)早期综合救治中的应用效果。方法选取昆明市第一人民医院自2020年1月至2023年3月收治的AOPP患者103例,其中,3例患者在转运途中死亡,最终纳入100例。根据急救方案分为常规组(n=48)与观察组(n=52)。常规组采取常规急救管理+杂合式血液净化,观察组采取规范化急救+杂合式血液净化。观察两组救治效果、急救相关情况[意识恢复时间、中毒症状消失时间、阿托品与盐酸戊乙奎醚使用剂量、胆碱酯酶(ChE)恢复正常时间、住院时间、呼吸机使用时间]、干预前后炎性指标[肿瘤坏死因子α(TNF-α)、转化生长因子β1(TGF-β1)、白细胞介素8(IL-8)]、并发症及急救行为能力。结果观察组救治效果良好率优于常规组,差异有统计学意义(P<0.05)。观察组意识恢复时间、中毒症状消失时间、ChE恢复正常时间、住院时间、呼吸机使用时间短于常规组,阿托品与盐酸戊乙奎醚使用剂量小于常规组,差异有统计学意义(P<0.05)。干预后48 h,两组TNF-α、TGF-β1、IL-8水平均较干预前降低,且观察组低于常规组,差异有统计学意义(P<0.05)。观察组并发症发生率为11.5%(6/52),低于常规组的33.3%(16/48),差异有统计学意义(P<0.05)。观察组出诊速度、抢救护理配合能力、应急能力、急救用物准备、抢救能力、整体护理质量均优于常规组,差异有统计学意义(P<0.05)。结论规范化急救联合杂合式血液净化能提高救治效果,增强急救行为能力,缩短救治时间,降低并发症发生率,减轻患者机体炎症反应。

Objective To explore the application effect of standardized emergency treatment combined with hybrid blood purification in the early comprehensive treatment of acute organophosphorus pesticide poisoning(AOPP).Methods A total of 103 AOPP patients admitted to the Kunming First People’s Hospital from January 2020 to March 2023 were selected.Among them,3 patients died during transit and 100 cases were finally included.They were divided into conventional group(n=48)and observation group(n=52)according to the first aid protocol.The conventional group received conventional emergency management and hybrid blood purification,while the observation group received standardized emergency management and hybrid blood purification.The treatment effects,emergency-related conditions[recovery time of consciousness,time of resolution of poisoning symptoms,dosage of atropine and penehyclidine hydrochloride,recovery time of cholinesterase(ChE),hospitalization time,ventilator use time],inflammatory indicators before and after intervention[tumor necrosis factor-α(TNF-α),transforming growth factor-β1(TGF-β1),interleukin-8(IL-8)],complications,and emergency behavior ability were observed in both groups.Results The observation group had a better rate of good salvage results than the conventional group,and the difference was statistically significant(P<0.05).The observation group had shorter recovery time of consciousness,time of resolution of poisoning symptoms,recovery time of ChE,hospitalization time,and use time of ventilator than the conventional group,and the doses of atropine and penehyclidine hydrochloride used were lower than those in the conventional group,with statistically significant differences(P<0.05).At 48 hours after intervention,the levels of TNF-α,TGF-β1 and IL-8 in both groups were lower than those before intervention,and those in the observation group were lower than the conventional group,and the differences were statistically significant(P<0.05).The complication rate of the observation group was 11.5%(6/52),which was lower than that of the conventional group[33.3%(16/48)],and the difference was statistically significant(P<0.05).The observation group’s speed of attendance,ability to cooperate in rescue care,emergency response ability,preparation of emergency supplies,rescue ability,and overall quality of care were all better than those of the conventional group,and the differences were all statistically significant(P<0.05).Con-clusion Standardized emergency treatment combined with hybrid blood purification can improve the treatment effect,enhance the ability of emergency behavior,shorten the treatment time,reduce the incidence of complications,and alleviate the inflammatory response.