[1]侯景玉,吴　畏,陈希妍,等.序贯性血液净化治疗急性重度有机磷农药中毒并发多器官功能障碍综合征疗效观察[J].新乡医学院学报,2016,33(2):126-129.[doi:10.7683/xxyxyxb.2016.02.012]
　HOU Jing-yu,WU Wei,CHEN Xi-yan,et al.Sequential blood purification for acute severe ganophosphorus pesticide poisoning accompanied with multiple organs dysfunction syndrome[J].Journal of Xinxiang Medical University,2016,33(2):126-129.[doi:10.7683/xxyxyxb.2016.02.012]
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序贯性血液净化治疗急性重度有机磷农药中毒并发多器官功能障碍综合征疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
33
期数:
2016年2
页码:
126-129
栏目:
临床研究
出版日期:
2016-02-05

文章信息/Info

Title:
Sequential blood purification for acute severe ganophosphorus pesticide poisoning accompanied with multiple organs dysfunction syndrome
作者:
侯景玉; 吴　畏; 陈希妍; 李广鹏; 张建新; 石金河
（新乡医学院第一附属医院急诊科，河南　卫辉　453100）
Author(s):
HOU Jing-yu; WU Wei; CHEN Xi-yan; LI Guang-peng; ZHANG Jian-xin; SHI Jin-he
（Department of Emergency，the First Affiliated Hospital of Xinxiang Medical University，Weihui 453100，Henan Province，China）
关键词:
机械通气; 血液灌流; 静静血液滤过; 有机磷农药中毒; 多器官功能障碍综合征
Keywords:
mechanical ventilation; hemoperfusion; continuous venovenous hemofiltration; pesticide poisoning; multiple organs dysfunction syndrome
分类号:
R595.4
DOI:
10.7683/xxyxyxb.2016.02.012
文献标志码:
A
摘要:
目的　探讨序贯性血液净化治疗急性重度有机磷农药中毒并发多器官功能障碍综合征（MODS）的临床效果。方法　将新乡医学院第一附属医院急诊科2013年4月至2015年4月收治的急性重度有机磷农药中毒并发MODS的54例患者根据治疗方法分为对照组（23例）和观察组（31例），对照组患者给予洗胃、导泻、纠正水电解质紊乱、酸碱平衡失调及机械通气等常规治疗；观察组患者在对照组患者治疗基础上给予序贯性血液灌流（HP）和连续静脉-静脉血液滤过（CVVH）治疗。分别对2组患者平均动脉压（MAP）、心率（HR）、血气指标、炎性因子水平、昏迷清醒时间、机械通气时间、胆碱酯酶恢复时间、住院时间、治愈率和病死率进行比较。结果　2组患者治疗前MAP、HR、酸碱度(pH)、动脉血二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）、血氧饱和度（SaO2）、白细胞介素-6（IL-6）、IL-10和肿瘤坏死因子α（TNF-α）比较差异均无统计学意义（P>0.05）。2组患者治疗后MAP、pH、PaO2、SaO2较治疗前均显著升高，HR和PaCO2较治疗前显著下降（P<0.05）；治疗后观察组患者MAP、pH、PaO2、SaO2较对照组显著升高，HR和PaCO2较对照组显著下降（P<0.05）；观察组患者治疗后血清IL-6、IL-10和TNF-α等较治疗前和对照组治疗后均显著下降（P<0.05），对照组患者治疗前后血清IL-6、IL-10和TNF-α水平比较差异无统计学意义（P>0.05）。观察组患者昏迷清醒时间、机械通气时间、胆碱酯酶恢复时间及住院时间均较对照组短（P<0.05）。对照组和观察组患者治愈率、病死率分别为69.57%、30.43%和90.32%、9.68%，观察组患者治愈率明显高于对照组，病死率明显低于对照组（P<0.05）。结论　序贯性血液净化治疗急性重度有机磷农药中毒并发MODS患者可提高抢救的成功率，降低病死率。
Abstract:
Objective　To explore the efficacy of comprehensive treatment combined with sequential hemoperfusion and continuous venovenous hemofiltration for acute severe ganophosphorus pesticide poisoning accompanied with multiple organs dysfunction syndrome(MODS).Methods　Fifty-four patients with acute severe ganophosphorus pesticide poisoning accompanied with MODS in emergency department of the First Affiliated Hospital of Xinxiang Medical University from April 2013 to April 2015 were divided into control group（n=23） and observation group（n=31） according to the treatment ways.The patients in control group were treated with comprehensive treatment such as gastric lavage，catharsis，correction of electrolyte disturbance and acid-base balance and mechanical ventilation；the patients in observation group were treated with sequential hemoperfusion（HP） and continuous venovenous hemofiltration（CVVH） on the basis of control group.The mean arterial blood pressure（MAP），heart rate（HR），index of blood gas，inflammation factor level，the time from coma to awaking，the time of mechanical ventilation，the time of cholinesterase（CHE） recovery，the time of stay hospital，cure rate and fatality were compared between the two groups.Results　There were no statistic difference of MAP,HR,pH,arterial partial pressure of carbon dioxide(PaCO2)，arterial partial pressure of oxygen （PaO2），arterial oxygen saturation （SaO2），interleukin 6（IL-6），IL-10 and tumor necrosis factor-α(TNF-α) of patients between the two groups before treatment（P>0.05）.After treatment, the MAP, pH,PaO2, SaO2 of patients in observation group and control group were significantly higher than before treatment; but the HR and PaCO2 of patients were significantly lower than before treatment（P<0.05）. After treatment, the MAP, pH, PaO2 and SaO2 of patients in observation group were significantly higher than those in control group, but the HR and PaCO2 of patients were significantly lower than those in control group（P<0.05）. After treatment, the serum levels of IL-6,IL-10 and TNF-α of patients in observation group were lower than before treatment in observation group and after treatment in control group（P<0.05）.There were no statistic difference of IL-6,IL-10 and TNF-α levels in serum of patients in control group before and after treatment（P>0.05）.The time from coma to awaking, mechanical ventilation, CHE recovery and stay hospital of patients in the observation group were significantly shorter than those in the control group (P<0.05).The cure rate and fatality rate in the control group was 69.57% and 30.43% respectively; the cure rate and fatality rate in the observation group was 90.32% and 9.68% respectively. The cure rate of patients in observation group was significantly higher than that in control group; the fatality rate was lower than that in control group(P<0.05). Conclusion　Sequential hemoperfusion and continuous venovenous hemofiltration for acute severe ganophosphorus pesticide poisoning accompanied with MODS can raise the success rate and reduce fatality rate.

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更新日期/Last Update: 2016-02-05