李志兴 梁泓源

早期血液灌流治疗急性重度有机磷农药中毒的临床分析

李志兴 梁泓源

目的 分析早期血液灌流治疗急性重度有机磷农药中毒的临床效果。方法 选取2013年4月～2015年4月本院收治的ASOPP患者96例，分为血液灌流组（HP组）50例和常规治疗组（非HP组）46例，2组均给予常规治疗，HP组在常规治疗基础上给予HP治疗。观察比较各组临床治愈率、住院时间、昏迷时间、机械通气时间、长托宁、阿托品及氯磷定用量、治疗前及治疗12、24 h的CHE水平。结果 与非HP组比较，HP组患者长托宁用量、阿托品用量及氯磷定用量减少，住院时间、昏迷时间及机械通气时间缩短，治愈率提高，差异有统计学意义（P＜0.05）。与组内治疗前比较，两组治疗后12 h和24 h后CHE均升高（P＜0.05）；且治疗后各时点HP组CHE均高于非HP组（P＜0.05）。结论 早期HP治疗急性重度有机磷农药中毒可提高临床治愈率和抢救效果，减少药物用量，降低多器官损伤程度。

血液灌流；急性重度有机磷中毒；临床研究；生化指标

【Abstract】

Objective To explore the clinical efficacy on early-stage hemoperfusion in acute severe organophosphorus pesticide poisoning. Methods A total of 96 patients to our hospital during April 2013 to April 2015，were randomly divided into the conventional therapy group（n=46）and hemoperfusion group（n=50）.In addition to gastric lavage，catharsis and other conventional treatment，patients in HPG were given HP. The cure rate，dosage of penehyclidine hydrochloride，atropineand pralidoxime chloride，duration of hospitalization，coma and mechanical ventilation，plasma cholinesterase

activity before and after treatment of all patients were statistically analyzed. Results Compared with non HP group， HP group of penehyclidine hydrochloride dosage， dosage of atropine and pralidoxime chloride dosage， hospitalization time， coma time and mechanical ventilation time， improve the cure rate， the difference was statistically significant（P＜0.05）. Compared with before treatment， the two groups after treatment 12 h and 24 h CHE were significantly higher（P＜ 0.05）， and the CHE group at each time point after treatment were higher than non HP group （P＜0.05）. Conclusion HP is effective in improving the cure rate and rescue effect of ASOPP，reducing dosage of drugs，reducing the degree of multiple organ injury，has clinical value.

【Key words】Hemoperfusion，Severe organophosphorus pesticide poisoning，Cinical research，Biochemical indices

在我国，有机磷是目前生产和使用最多的一种农药，毒性高，农药中毒中80%～90%为有机磷农药中毒［1］。每年有高达10万例急性有机磷中毒（AOPP），其死亡率在4%～30%［2］，尤其是急性重度有机磷中毒患者。随着血液净化技术的发展，血液灌流（HP）通过活性炭的吸附作用将体内毒物清除到体外，达到净化血液的效果。为进一步分析血液灌流在治疗急性重度有机磷中毒中的应用价值，现报告如下。

1　资料与方法

1.1一般资料

选取2013年4月～2015年4月本院收治的ASOPP患者96例，中毒途径均为口服。中毒前均无心、脑、肺、肝和消化道等病史。……