摘要
目的:观察连续性静脉-静脉血液滤过(CVVH)联合血液灌流(HP)治疗重度有机磷中毒(ASOPP)的临床疗效。方法:回顾性分析126例ASOPP患者资料,根据治疗方式分为CVVH+HP组(n=60)和HP组(n=66)。观察疗效和治疗情况,记录患者治疗前(T1)及治疗后4h(T2)、24h(T3)、72h(T4)时血清胆碱酯酶(CHE)水平,比较两组T1、T3时血清炎症因子[白介素-1β(IL-1β)、白介素-6(IL-6)、白介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)]以及对肝肾损伤相关指标[胱抑素(CysC)、前白蛋白(PA)、高迁移率族蛋白B1(HMGB1)]水平差值,观察并发症发生情况。结果:CVVH+HP组痊愈率为93.33%,高于HP组的78.79%(P<0.05);两组反跳发生率差异无统计学意义(P>0.05)。CVVH+HP组阿托品、氯解磷定用量分别为(143.37±18.72)mg、(10.28±2.62)g,少于HP组的(154.18±21.47)mg、(19.57±4.31)(均P<0.05);CVVH+HP组昏迷时间、住院时间分别为(13.38±3.41)h、(7.26±1.58)d,短于HP组的(22.15±4.14)h、(8.42±1.74)d(均P<0.05)。T2~T4时,两组血清CHE水平逐渐升高,且CVVH+HP组升高幅度大于HP组(均P<0.05)。T1时,两组血清IL-1β、IL-6、IL-10、TNF-α水平和血清CysC、PA、HMGB1水平差异无统计学意义(P>0.05);CVVH+HP组血清IL-1β、IL-6、IL-10、TNF-α、CysC、PA、HMGB1的T1-T3差值大于HP组(均P<0.05)。两组并发症发生情况差异无统计学意义(P>0.05)。结论:相较于HP单用,CVVH+HP治疗ASOPP可提升治愈率,改善治疗情况,促进血清CHE活性恢复,减轻炎症反应,缓解脏器损伤,且安全性良好,有一定优势。
Objective:To observe the clinical efficacy of continuous veno-venous hemofiltration(CVVH)combined with hemoperfusion(HP)in the treatment of severe acute organophosphorus poisoning(ASOPP).Methods:The data of 126 patients with ASOPP were retrospectively analyzed.According to the treatment methods,the patients were divided into CVVH+HP group(n=60)and HP group(n=66).The efficacy and treatment were observed.Serum cholinesterase(CHE)level was recorded before treatment(T1)and at 4h(T2),24h(T3)and 72h(T4)after treatment.The differences of serum inflammatory factors[interleukin-1β(IL-1β),interleukin-6(IL-6),interleukin-10(IL-10),tumor necrosis factor-α(TNF-α)]and liver-kidney injury related indicators[cystatin C(CysC),prealbumin(PA),high mobility group protein B1(HMGB1)]were compared between the two groups at T1 and T3,and the occurrence of complications was observed.Results:The cure rate was 93.33%in CVVH+HP group,which was higher than 78.79%in HP group(P<0.05).There was no statistical significance in the incidence rate of rebound between the two groups(P>0.05).The dosages of atropine and pralidoxime chloride with(143.37±18.72)mg and(10.28±2.62)g in CVVH+HP group were less than(154.18±21.47)mg and(19.57±4.31)g in HP group(all P<0.05).The coma time and hospital stay in CVVH+HP group were(13.38±3.41)h and(7.26±1.58)d,which were shorter than(22.15±4.14)h and(8.42±1.74)d in HP group(all P<0.05).At T2~T4,the level of serum CHE in the two groups was increased gradually,and the increase in CVVH+HP group was greater than that in HP group(all P<0.05).At T1,the levels of serum IL-1β,IL-6,IL-10 and TNF-αand serum CysC,PA and HMGB1 revealed no statistical differences between the two groups(P>0.05).The differences of serum IL-1β,IL-6,IL-10,TNF-α,CysC,PA and HMGB1 at T1-T3 were greater in CVVH+HP group than those in HP group(all P<0.05).There was no statistical difference in the occurrence of complications between the two groups(P>0.05).Conclusion:Compared with HP alone,CVVH+HP for ASOPP can enhance the cure rate,improve the treatment,promote the recovery of serum CHE activity,alleviate the inflammatory response and relieve the organ damage,and it has good safety and certain advantages.
作者
漆小莉
熊明分
陶宁
胡建平
黄柳
QI Xiaoli;XIONG Mingfen;TAO Ning(Suining Central Hospital,Sichuan Suining 629000,China)
出处
《河北医学》
CAS
2024年第2期281-286,共6页
Hebei Medicine
基金
四川省基层卫生事业发展研究中心立项项目,(编号:SWFZ17-Y-39)。
关键词
有机磷中毒
重度
血液灌流
连续性静脉-静脉血液滤过
Organophosphorus poisoning
Severe
Hemoperfusion
Continuous veno-venous hemofiltration
