碘解磷定注射液联合血液灌流治疗有机磷中毒的临床研究

Clinical Study on Iodine Phosphodine Injection Combined Hemoperfusion in the Treatment of Organic Phosphorus Poisoning

目的观察碘解磷定注射液联合血液灌流治疗有机磷中毒的临床效果。方法本研究为前瞻性研究,研究对象为信阳一五四医院2022年1月~2023年12月期间收治的96例有机磷中毒患者,应用电脑随机分组法将其分别列为药物组(48例)和联合组(48例),药物组采用碘解磷定注射液治疗,联合组采用碘解磷定注射液联合血液灌流术治疗,比较两组患者的胆碱酯酶(CHE)活性,症状缓解情况,炎症指标,脏器损伤情况及预后情况。结果在不同治疗方案下,联合组治疗24h、48h、72h后的CHE活性水平分别为(68.33±10.25)%、(75.29±10.43)%、(85.36±10.24)%,均高于药物组[(63.29±10.44)%、(70.32±10.34)%、(80.29±10.47)%](t=2.387、2.345、2.399;P<0.05);联合组的中枢神经症状、毒蕈碱样症状、烟碱样症状、呼吸系统症状消失时间、住院时间分别为(4.23±1.25)h、(0.55±0.14)h、(1.34±0.27)h、(0.85±0.19)h、(5.75±1.32)d,均低于药物组[(5.18±1.44)h、(0.83±0.21)h、(1.81±0.45)h、(1.21±0.51)h、(6.61±1.75)d](t=3.452、7.686、6.205、4.583、2.718;P<0.05);联合组的C-反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)分别为(5.32±1.24)mg/L、(0.52±0.13)μg/L、(140.23±20.22)pg/ml,均低于药物组[(6.21±1.49)mg/L、(0.88±0.21)μg/L、(155.39±20.45)pg/ml](t=3.287、10.099、3.652;P<0.05);联合组的乳酸脱氢酶(LDH)、谷丙转氨酶(AST)、肌酐(SCr)分别为(230.35±20.46)U/L、(38.44±5.28)U/L、(160.25±20.33)μmol/L,均低于药物组[(245.22±20.32)U/L、(41.35±5.36)U/L、(175.33±20.41)μmol/L](t=3.573、2.670、3.627;P<0.05);联合组的不良预后发生率4.17%(2/48)低于药物组20.83%(10/48)(x2=6.095;P<0.05)。结论碘解磷定注射液联合血液灌流能有效降低有机磷中毒患者的CHE活性,对促进患者症状恢复,减轻炎症反应、脏器损伤并改善预后情况均有积极意义。

Objective Observing the clinical effect of iodine phosphate injection combined blood perfusion in the treatment of organic phosphorus poisoning.Methods This study is a prospective study,with 96 patients with organic phosphorus poisoning admitted to our hospital from January 2022 to December 2023.They were randomly divided into a drug group(48 cases)and a combination group(48 cases)using a computer randomization method.The drug group received blood perfusion surgery,while the combination group received iodine phosphate injection combined blood perfusion surgery.The CHE activity,symptom relief,inflammatory indicators,organ damage,and prognosis of the two groups of patients were compared.Results Under different treatment regimens,the CHE activity levels in the combination group after 24 hours,48 hours,and 72 hours of treatment were(68.33±10.25)%,(75.29±10.43)%,and(85.36±10.24)%,higher than he drug group[(63.29±10.44)%,(70.32±10.34)%,and(80.29±10.47)%](t=2.387,2.345,2.399;P<0.05);the central nervous system symptoms,muscarinic like symptoms,nicotinic like symptoms,respiratory system symptoms disappearance time,and hospital stay in the combination group were(4.23±1.25)h,(0.55±0.14)h,and(1.34±1.25)h,(0.85±0.19)h,and(5.75±1.32)d,lower than those in the drug group[(5.18±1.44)h,(0.83±0.21)h,(1.81±0.45)h,(1.21±0.51)h,(6.61±1.75)d](t=3.452,7.686,6.205,4.583,2.718;P<0.05);CRP,PCT and IL-6 in the combination group were(5.32±1.24)mg/L,(0.52±0.13)μg/L,and(140.23±20.22)pg/ml,lower than the drug group[(6.21±1.49)mg/L,(0.88±0.21)μg/L,(155.39±20.45)pg/ml](t=3.287,10.099,3.652;P<0.05);LDH,AST,and SCr in the combination group were(230.35±20.46)U/L,(38.44±5.28)U/L,and(160.25±20.33)μmol/L,lower than the drug group[(245.22±20.33)μmol/L,respectively 32)U/L,(41.35±5.36)U/L,(175.33±20.41)μmol/L[t=3.573,2.670,3.627;P<0.05];the incidence of adverse prognosis in the combination group was 4.17%(2/48)lower than the drug group 20.83%(10/48)(x2=6.095;P<0.05).Conclusion Iodine phosphate injection combined blood perfusion can effectively reduce CHE activity in patients with organic phosphorus poisoning,promote symptom recovery,alleviate inflammatory reactions,organ damage,and improve prognosis.