Abstract
Objective To investigate the clinical efficacy of combined treatment of digestive tract and HP in patients with acute severe organophosphorus pesticide poisoning. Methods 120 patients with severe organic phosphorus poisoning from April 2015 to April 2010 were randomly divided into the observation group and the control group, 60 cases in each group. The control group was treated with gastric lavage, catharsis, detoxification of atropine, pralidoxime chloride complex and symptomatic treatment. On the basis of the control group, the observation group, within 6 h after gastric lavage, was given 20% mannitol for catharsis, medicinal activated carbon adsorption and other means of cleaning in the digestive tract of poison, 6 to 12 h given hemoperfusion in treatment, a second blood irrigation flow time for 12 to 24 h. Before treatment and 3 d after treatment, the serum creatinine ( SCR, mol/L ) , cystatin ( Crs-C, mg/L ) , aspartate aminotransferase ( AST, U/L ) , serum creatine kinase isoenzyme ( CK-MB, mg/L ) level were detected by American Beckman Coulter AU5800 automatic biochemical analyzer, and the immune learning method was used to detect the serum cardiac troponin I ( cTnI light mg/L ) and atropine. The results were compared between two groups using amount ( mg ) and atropine peak time ( H ) and intermediate syndrome occurrence rate (%) , acute physiology and chronic health score maximum ( APACHEmax Ⅱ) and fatality rate difference. Results Before entering the group, there no statistically significant difference in age, gender, history of foundation, poison dose, poison types, poison treatment time between the two groups ( P ﹥ 0. 05 ) . Before treatment, there was no statistically significant difference in the serum Scr, Crs-C, CK-MB, AST and cTnI between the two groups ( P ﹥ 0. 05 ) . After treatment, the observation group showed significant reduce compared with the control group in blood Scr [ ( 142. 95 ± 21. 36 )μmol/L vs ( 189. 47 ± 20. 35 )μmol/L, t=2. 871 ] , Crs-C [ ( 1. 54 ± 0. 31 ) mg/L vs ( 2. 89 ± 0. 45 ) mg/L, t=3. 219 ] , AST [ ( 59. 05 ± 9. 02 ) U/L vs ( 80. 90 ± 11. 06 ) U/L, t=3. 329 ] , CK-MB [ ( 39. 80 ± 4. 62 )μg/L vs ( 52. 18 ± 6. 39 )μg/L, t=3. 164 ] , cTnI [ ( 0. 91 ± 0. 12 ) mg/L vs ( 1. 53 ± 0. 41 ) mg/L, t=3. 684 ] ( P ﹤ 0. 05 ) . Compared the observation group with the control group, the amount of atropine [ ( 51. 90 ± 12. 17 ) mg vs ( 83. 27 ± 11. 46 ) mg, t=3. 286 ] , cholinesterase recovery time [ ( 5. 13 ± 0. 92 ) d vs ( 8. 09 ± 1. 23 ) d, t=2. 981 ] , the incidence of intermediate syndrome [ ( 36/60, 60. 00%) vs ( 48/60, 80. 00%) , χ2=2. 871 ] , acute physiology and chronic health evaluation Max ( APACHEmax Ⅱ) [ ( 23. 17 ± 3. 28 ) vs ( 29. 06 ± 5. 28 ) , t=3. 129 ] and mortality [ ( 6/60, 10. 00% ) vs ( 15/60, 25. 00% ) , reducing χ2=2. 905 ] the difference between the two groups were statistically significant ( P ﹤ 0. 05 ) . Conclusion Digestive tract cleaning combined with blood perfusion can effectively reduce the secondary injury of organ function in patients with acute severe organophosphorus pesticide poisoning, reduce the use of at-ropine as well as the incidence of complications and clinical mortality, which is worthy of clinical application.关键词
血液灌流/重度/有机磷中毒/临床疗效Key words
HP/severe/organic phosphorus poisoning/clinical efficacy分类
医药卫生
