血浆置换联合血液灌流治疗急性重度有机磷农药中毒的疗效及对患者肝功能的影响

目的:探讨血浆置换联合血液灌流治疗急性重度有机磷农药中毒的临床疗效及对患者肝功能的影响。方法:选择我院于2014年1月至2017年9月收治的66例急性重度有机磷农药中毒患者,按照随机原则分为血液灌流组(n=30)、联合治疗组(n=36),两组均接受急性重度有机磷农药中毒常规治疗,在此基础上血液灌流组和联合治疗组分别接受血液灌流、血浆置换联合血液灌流治疗。观察两组治疗效果,治疗前、治疗1周后血浆丙氨酸转氨酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素水平。观察治疗过程中的不良反应发生情况。结果:与血液灌流组比较,联合治疗组胆碱酯酶(CHE)恢复时间较短,而长托宁用量较少,住院时间较短,且抢救成功率较高(P0.05)。治疗1周后联合治疗组血浆ALT、AST、总胆红素显著低于血液灌流组(P0.05)。治疗过程联合治疗组出现1例皮疹,不良反应发生率为2.78%,血流灌注组无不良反应发生,两组不良反应发生率比较无差异(P0.05)。结论:血浆置换联合血液灌流能明显提高急性重度有机磷中毒患者的抢救成功率,同时改善患者肝功能,且安全性良好,值得临床推广。

Effect of Plasma Exchange combine with Hemoperfusion on Acute Severe Organophosphorus Pesticide Poisoning and Its Influence on Liver Function

ABSTRACT Objective: To investigate the clinical efficacy of plasma exchange combine with hemoperfusion on acute severe organophosphorus pesticide poisoning and its influence on liver function. Methods: 66 patients with acute severe organophosphorus pesticide poisoning who were treated in our hospital from January 2014 to September 2017 were seleced, according to the principle of randomization, the patients were divided into hemoperfusion group (n=30) and combined treatment group (n=36), the two groups received conventional treatment of acute severe organophosphorus pesticide poisoning, on this basis, hemoperfusion group and combined treatment group were treated with hemoperfusion, plasma exchange combined with hemoperfusion. The treatment effects between the two groups,plasma alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin levels before and after 1 weeks of treatment were observed, the adverse reactions during the treatment were observed. Results: Compared with hemoperfusion group, the cholinesterase (CHE) recovery time in the combined treatment group were shorter, the amount of penehyclidine hydrochloride was less,the hospitalization time was shorter, while the success rate of rescue was higher (P<0.05). The plasma levels of ALT, AST and total bilirubin in the combined treatment group were significantly lower than those in the hemoperfusion group (P<0.05). There were 1 case of rash in the combined treatment group, the incidence of adverse reactions was 2.78%, and there were no adverse reactions occurred in the hemoperfusion group, there was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: Plasma exchange combine hemoperfusion can significantly improve the successful rate of salvage in patients with acute severe organophosphorus pesticide poisoning,can improve the liver function of patients and have good safety,which is worthy of clinical promotion.