摘要
目的探讨血液灌流联合血液滤过治疗重度急性有机磷农药中毒(AOPP)法疗效和预后,为临床重度AOPP的治疗提供参考。方法方便收集2010年2月—2017年2月该院急诊科收治的重度AOPP患者72例。根据治疗方法分为常规组(n=23)、HP+CVVH组(n=25)、强化HP+CVVH组(n=24)。常规组采用常规治疗方法。HP+CVVH组在常规组基础上进行1次HP+CVVH;强化HP+CVVH组在常规组基础上进行≥2次HP+CVVH。观察3组患者的昏迷时间、胆碱酯酶(Ch E)恢复正常时间、阿托品用量及中间综合征、反跳现象、心律失常、多器官功能衰竭综合征(MODS)等并发症及死亡率情况。结果 HP+CVVH组、强化HP+CVVH组的昏迷时间、ChE恢复正常时间、阿托品用量分别为[(6.5±0.5)h、(42.3±20.6)d、(202.5±30.8)mg]、[(5.0±0.6)h、(24.7±10.8)d、(169.2±31.4)mg]明显低于常规组的[(18.2±0.8)h、(88.3±25.7)d、(274.3±45.8)mg](P<0.05),强化HP+CVVH组的昏迷时间、Ch E恢复正常时间、阿托品用量明显低于HP+CVVH组(P<0.05)。HP+CVVH组、强化HP+CVVH组的中间综合征、反跳现象、心律失常、MODS、死亡发生率分别为(16.0%、24.0%、40.0%、36.0%、24.0%)、(8.3%、8.3%、16.7%、20.8%、12.5%)明显低于常规组的(30.4%、43.5%、65.2%、60.9%、43.5%)(P<0.05)。结论对重度AOPP,在给予常规内科治疗同时,给予2次或以上HP联合CVVH治疗可明显提高疗效,改善病死的预后,值得临床推广借鉴。
Objective This p a p e r tr ies to inves tig ate th e efficacy and prognosis of h emoperfusion comb in ed with hem o fil tra-tion in the treatment of severe acute organophosphorus pest icide poisoning （AOPP）, and to provide reference for the treat-ment of severe acute AOPP. Methods 7 2 p a t ien ts with severe AOPP adm it ted in this h o sp i ta l eme rg en cy d ep a r tm en t from February 2010 to February 2017 were convenient selected. The patients were divided into the routine group （n =23）, th e HP＋CVVH group （n=25） and the intens ive HP＋CVVH group （n=24） according to the treatment methods. The routine treat -ment was adopted in the routine group. HP＋CVVH group added a course of HP＋CVVH on the bas is of the rout ine group; the intensive HP＋CVVH group added twice HP＋CVVH on the bas is of the routine group. The coma time, chol inesterase （ChE） recovery time, the dosage of atropine and intermediate syndrome, rebound phenomenon, ar rhythmia and multiple or -gan dys function syndrome （MODS） and other complicat ions and mortality of the three groups were observed. Results The coma time, ChE recovery time, the dosage of atropine in the HP＋CVVH group and the intensive HP＋CVVH group were re-spectively [（6.5±0.5）h, （42.3±20.6）days , （202.5±30.8）mg], [（5.0±0.6）h, （24.7±10.8）days , （169.2±31.4）mg], signif icantly lower than the routine group of [（18.2±0.8）h, （88.3±25.7）days , （274.3±45.8）mg] （P〈0.05） , coma time, ChE recovery time, thedosage of atropine in the intensive HP＋CVVH group was signif icantly lower than that of HP＋CVVH group （P〈0.05） . The middle term syndrome, rebound phenomenon, ar rhythmia, MODS and death rates in the HP＋CVVH group and the intens ive HP＋CVVH group were （16.0%, 24.0%, 40.0%, 36.0%, 24.0%）,（8.3%, 8.3%, 16.7%, 20.8%, 12.5%）, signif icantly lower than the routine group of （30.4%, 43.5%, 65.2%, 60.9%, 43.5%） （P〈0.05）. Conclusion For severe AOPP, on th e bas is of routine treatment, twice or more HP combined with CVVH treatment can improve the curative effect and improve the prognosis of the pat ients with routine medical treatment. It is worthy of cl inical reference.
出处
《中外医疗》
2017年第26期25-27,共3页
China & Foreign Medical Treatment
关键词
血液灌流
血液滤过
急性有机磷农药中毒
Hemoperfusion
Hemofiltration
Acu te organophosphorus p e s t ic id e poisoning
