急性重度敌敌畏中毒患者血清儿茶酚胺水平与其心脏损伤的关系

目的:探讨急性重度敌敌畏中毒患者血清儿茶酚胺水平与其心脏损伤的关系。方法:选取我院2009年12月至2011年12月收治的急性重度敌敌畏中毒患者40例,接受阿托品和氯解磷定等常规治疗,检测患者入院第1、3、5天血清肌酸激酶(CK-MB)、心肌肌钙蛋(CTNI)、胆碱酯酶(AchE)、乙酰胆碱(Ach)、肾上腺素(EPI)和去甲肾上腺素(NorP)等指标,分析患者血清儿茶酚胺水平与其心脏损伤的关系。结果:40例患者中,34例存活,6例死亡;窦性心动过速35例,心电图(ECG)ST-T改变36例;血清CK-MB、CTNI入院第1、3、5天相比,先升高后降低,出院时降至正常,变化差异有统计学意义(CK-MB:H=8.782,P=0.002;CTNI:H=5.017,P=0.024)。Ach入院第1天时最高,逐渐降低,出院时恢复到正常水平,变化差异有统计学意义(H=9.235,P=0.002;AchE入院第1天时最低,逐渐升高至正常,变化差异有统计学意义(H=46.891,P=0.001)。肾上腺素(EPI)和去甲肾上腺素(NorP)代表儿茶酚胺的变化,入院当天为峰值,其后均逐渐下降,出院恢复正常,变化差异有统计学意义(EPI:H=16.031,P=0.021;NorP:H=57.913,P=0.025)。进一步分析显示EPI和与NorP水平分别与CK-MB和CTNII呈显著正相关,差异均具有统计学意义(P0.05)。结论:敌敌畏中毒时,儿茶酚胺与乙酰胆碱的释放增多,可能引起心肌损害或加重心肌缺血的严重程度。

Relationship between the Heart Injury and Catecholamine Level of Patients with Severe Acute Dichlorvos Poisoning

Objective:To study the relationship between the heart injury and catecholamine level of patients with severe acute dichlorvos poisoning.Methods:40 patients with severe acute dichlorvos poisoning admitted in our hospital from December 2009 to December 2012 were selected. The alteration of creatine kinase-MB (CKMB), cardiac troponin I (CTNI), acetylcholinesterase(AchE), acetylchoine (Ach), epinephrine (EPI) and norepinephrine(NorP) levels were detected for patients with atropine and chlorine phosphate solubilizing sst routine tharpy on the 1st, 3rd and 5th day after admission. And the relationship between the catecholamine levels and the heart damage was analyzed.Results:In 40 patients, 34 patients lived and 6 cases died. 35 patients had sinus tachycardia and 36 patients with ST-T change. Serum CK-MB, CTNI increased at first and then dropped to normal. The difference was statistically significant (CK-MB; H=8.782, P=0.002; CTNI: H=5.017, P=0.024). Ach admission by 1 supreme, and gradually reduce, the hospital returned to normal level. The difference was statistically significant (H=9.235, P=0.002). AchE admission minimum, and gradually rise to normal. The difference was statistically significant(H=46.891, P=0.001). EPI and NorP on behalf of catecholamine changes, to the hospital for the peak, then decreased gradually and at last returned to normal. The difference was statistically significant(EPI: H=16.031, P=0.021; NorP: H=57.913, P=0.025).Conclusion:Dichlorvos poisoning could increase the release of catecholamines and acetylcholine, which may cause myocardial damage or worsen the severity of myocardial ischemia.