Abstract
Objective To investigate the protective effect of hemoperfusion combined with continuous renal replacement therapy in the treatment of heart and kidney injury in elderly patients with severe organophosphorus poisoning. Methods 120 patients with severe organophosphorus poisoning from September 2010 to June 2015 were randomly divided into the combination group and the control group,60 cases in each group. The control group was treated with routine gastric lavage,enema intestinal poison removal,atropine detoxi-fication,chlorine pralidoxime complex agent rehydration symptomatic treatment,and 12 h after admission,hemoperfusion was given once for 2-4 h. On this basis,the combination group was treated with continuous blood purification(CVVH)after 12 h,and the duration was 24-48 h. During each 12 h,the blood filtration treatment was given for a total of 3 times. Before treatment and at 3 d after treatment, the levels of IL-6 and TNF-α were detected by ELISA and the CRP level was detected by the immunoturbidimetry. The levels of SCr,Cys-C,CK-MB were detected by full automatic biochemical analyzer. The levels of cTnⅠand BNP were detected by immuno-chemical assay. The recovery time,acute physiology and chronic health status(APACHEmax Ⅱ),mechanical ventilation support time,me-chanical ventilation support time,pulmonary infection rate,and mortality in the two groups were observed and compared. Results After 3 d of treatment,the index levels in the combination group and the control group were as follows,IL-6 [(51. 49 ± 8. 53) ng/L vs (81. 06 ± 9. 62)ng/L,t=3. 084 ] ,CRP [(34. 81 ± 6. 05)mg/L vs(61. 85 ± 7. 38 )mg/L,t=3. 541 ] ,TNF-α [(46. 82 ± 7. 36)ng/L vs (68. 05 ± 9. 36)ng/L,t=2. 983 ] the levels in both groups decreased compared with before treatment,and the two groups also had sta-tistically significant difference( P < 0. 05);SCr [(123. 74 ± 22. 80) μmol/L vs (180. 63 ± 20. 62) μmol/L,t=2. 897 ] ,Cys-C [(1. 53 ± 0. 31) mg/L vs (2. 38 ± 0. 61) mg/L,t=3. 035 ] ,BNP [(490. 31 ± 62. 87) ng/mL vs (1 598. 46 ± 54. 29) ng/mL, t=3. 806 ] ,CK-MB [(42. 80 ± 5. 48)μg/L vs(60. 92 ± 8. 63)μg/L,t=3. 369 ] ,cTnⅠ[(0. 93 ± 0. 13)mg/L vs(1. 89 ± 0. 61)mg/L, t=3. 995 ] ,which were also significantly decreased compared with before treatment,and the two groups also had statistically significant difference ( P < 0. 05);the blood cholinesterase recovery time [(6. 69 ± 1. 04) d vs (8. 99 ± 1. 34) d,t=3. 095 ] ,APACHEmax Ⅱ[(24. 80 ± 5. 43) vs(30. 54 ± 6. 29),t=3. 905 ] ,mechanical ventilation time [(5. 94 ± 1. 36)d vs(9. 06 ± 1. 28)d,t=3. 319 ] ,the in-cidence of lung infection [(10/60,16. 67% ) vs (22/60,36. 67% ),χ2=3. 061 ] and mortality [(6/60,10. 00% ) vs (14/60, 23. 33%),χ2=2. 984 ] which were also significantly decreased compared with before treatment,and the two groups also had statistically significant difference( P < 0. 05). Conclusion Hemoperfusion combined with continuous renal replacement therapy can effectively re-move inflammatory mediators in the patients,and has protective effect on the heart and kidney injury of elderly patients with severe organophosphorus poisoning.关键词
血液灌流/连续性肾脏替代治疗/重度/有机磷中毒/心肾损伤Key words
hemoperfusion/continuous renal replacement therapy/severe/prganophosphorus poisoning/heart and kidney injury分类
医药卫生
