王海波 刘伟 胡泉清 张桂英 刘敦胜

[摘要] 目的 研究早期血液灌注聯合透析治疗急性有机磷中毒的临床效果。 方法 研究对象方便选取该院2015年5月—2017年5月间收治的急性有机磷中毒患者62例，采取数字随机法将其平均分为观察组（n=31）和对照组（n=31）。对照组患者采取常规急救措施，进行洗胃、正压给氧、体液复苏等对症处理，在其基础上，对观察组患者实行血液净化治疗，比较两组患者的临床治疗效果、转归情况及并发症发生情况。 结果 观察组患者住院时间、胆碱酯酶活性的恢复时间、昏迷至清醒时间及阿托品使用剂量均明显低于对照组（P<0.05）;观察组患者完全治愈率明显高于对照组，不完全治愈率、死亡率均明显低于对照组（P<0.05）;观察组患者术后并发症发生率（19.35%）明显低于对照组（67.74%）（χ2=14.76，P=0.00）。 结论 采用血液灌注联合透析治疗急性有机磷中毒可有效提高抢救效率，降低死亡率，且患者临床转归情况理想，临床效益较好，值得推广实践。

[关键词] 早期血液灌注;血液透析;急性有机磷中毒;临床效果

[中图分类号] R595.4          [文献标识码] A          [文章编号] 1674-0742（2018）08（c）-0037-03

Clinical Study of Early Hemoperfusion Combined with Dialysis in the Treatment of Acute Organophosphorus Poisoning

WANG Hai-bo1， LIU Wei2， HU Quan-qing1， ZHANG Gui-ying1， LIU Dun-sheng1

1.Laixi People's Hospital， Laixi， Shandong Province， 266600 China; 2.Laixi Dianbu Hospital， Laixi， Shandong Province， 266600 China

[Abstract] Objective To study the clinical effect of early hemoperfusion combined with dialysis on acute organophosphorus poisoning. Methods 62 patients with acute organophosphorus poisoning who were convenient admitted to the hospital between May 2015 and May 2017 were randomly selected and divided into observation group （n=31） and control group （n=31）. The patients in the control group took conventional first-aid measures to carry out symptomatic treatment such as gastric lavage， positive pressure oxygen， and body fluid resuscitation. On the basis thereof， the patients in the observation group were subjected to blood purification treatment， and the clinical treatment effects and outcomes， complications occurred of the two groups were compared. Results The hospitalization time， recovery time of cholinesterase activity， coma to awake time and atropine use dose in the observation group were significantly lower than those in the control group （P<0.05）. The complete cure rate was significantly higher in the observation group than in the control group. The cure rate and death rate were significantly lower than those in the control group （P<0.05）. The incidence of postoperative complications in the observation group （19.35%） was significantly lower than that in the control group （67.74%） （χ2=14.76， P=0.00）. Conclusion The use of blood perfusion combined with dialysis in the treatment of acute organophosphorus poisoning can effectively improve the rescue efficiency and reduce the mortality rate. The clinical outcome of the patients is ideal and the clinical benefits are good. It is worthy of promotion and practice.

[Key words] Early blood perfusion; Hemodialysis; Acute organophosphorus poisoning; Clinical effects

急性有机磷农药中毒是临床内科常见的危急重症之一，国内农村地区发病率较高。中毒程度轻者由于神经麻痹可表现为瞳孔缩小、呼吸困难及寒战等，病情严重者可累及身体各器官导致器官功能障碍，或可由于心血管系统及淋巴系统功能障碍引发周围循环衰竭死亡，临床病死率与致残率均较高，因此早期采取积极有效的方法进行抢救治疗对患者意义重大[1]。阿托品、胆碱酯酶复能剂等药物是常用的解毒药物，对轻中度中毒治疗效果显著，但对重度中毒患者仅可缓解症状，完全治愈率较低[2]。血液灌流与血液透析治疗是被广泛应用于临床血液净化治疗的方法，近年来，也被证明对治疗急性有机磷中毒具有显著效果。……