淡华臣 汤斌 曹晨 沈百庆 薛金光

[摘要] 目的 研究分析長托宁联合血液灌流治疗重度有机磷农药中毒的效果及对胆碱酯酶等方面的改善效果。 方法 选取2015年12月至2020年12月我院收治的83例重度有机磷农药中毒患者作为研究对象，按照治疗方法的不同分为对照组（n=40）与研究组（n=43）。所有患者均接受常规处理，对照组联合使用长托宁药物治疗，研究组在对照组基础上联合血液灌流治疗。比较两组疗效、胆碱酯酶恢复情况、炎症因子及不良反应情况。 结果 研究组患者临床总有疗效率为81.40%，高于对照组的57.50%，差异有统计学意义（P<0.05）;干预后，研究组患者胆碱酯酶水平为（2886.36±46.25）U/L，高于对照组的（2556.32±41.25）U/L，差异有统计学意义（P<0.05）;研究组胆碱酯酶恢复时间为（5.68±1.02）d，短于对照组的（6.50±1.58）d，差异有统计学意义（P<0.05）。两组患者白介素-4（IL-4）和肿瘤坏死因子-α（TNF-α）炎症因子水平均低于治疗前，且研究组患者IL-4和TNF-α水平低于对照组，差异均有统计学意义（P<0.05）;两组不良反应总发生率比较，差异无统计学意义（χ2=0.585，P=0.445>0.05）。 结论 重度有机磷农药中毒患者采取长托宁联合血液灌流治疗方案，有利于改善炎症因子，促进胆碱酯酶恢复，提升临床疗效，保护患者生命安全。

[关键词] 重度有机磷农药中毒;血液灌流;长托宁;胆碱酯酶;氧化应激

[中图分类号] R595.4          [文献标识码] B          [文章编号] 1673-9701（2021）32-0121-04

[Abstract] Objective To study and analyze the effect of Changtuoning combined with hemoperfusion （HP） in the treatment of severe organophosphorus pesticide poisoning and the improvement effect on cholinesterase. Methods A total of 83 patients with severe organophosphorus pesticide poisoning who were admitted to our hospital from December 2015 to December 2020 were selected as the study subjects. According to the different treatment methods， they were divided into the control group （n=40） and the study group （n=43）. All patients in two groups received routine treatment. Then the control group was treated with a combination of Changtuoning drug treatment， while the study group was treated with a combination of HP therapy on the basis of the same treatment as the control group. The efficacy， recovery of cholinesterase， inflammatory factors and adverse reactions were compared between the two groups. Results The total effective rate of clinical treatment in the study group （81.40%） was higher than that of （57.50%） in the control group with statistically significant difference （P<0.05）. After intervention， the level of cholinesterase in the study group （2886.36±46.25）U/L was higher than that in the control group （2556.32±41.25）U/L， with statistically significant difference （P<0.05）. The cholinesterase recovery time in the study group （5.68±1.02）d was shorter than that in the control group （6.50±1.58）d， with statistically significant difference（P<0.05）. The levels of inflammatory factors such as interleukin-4 （IL-4） and tumor necrosis factor-α （TNF-α） in the two groups after treatment were lower than those before treatment， and the levels of IL-4 and TNF-α in the study group were lower than those in the control group， with statistically significant differences （P<0.05）. There was no statistically significant difference in terms of incidence of adverse reactions between the two groups （χ2=0.585， P=0.445>0.05）. Conclusion For patients with severe organophosphorus pesticide poisoning， the combination of Changtuoning and HP therapy is beneficial to improve inflammatory factors， promote the recovery of cholinesterase， enhance clinical efficacy， and protect patient′s life safety.

[Key words] Severe organophosphorus pesticide poisoning; Hemoperfusion; Changtuoning; Cholinesterase; Oxidative stress

重症有机磷农药中毒是临床常见的危急症状，导致患者副交感神经兴奋，引起M样、N样作用，增强呼吸道腺体分泌，诱发肺水肿、呼吸衰竭等严重症状，具有较高致死率[1]。以往临床对于急性有机磷农药中毒患者通过药物方式加以干预，长托宁是治疗有机磷农药中毒的常用药，是一类新型的抗胆碱能药物，疗效好、半衰期长，其受体特异性强且毒副作用小，但单一用药疗效有限，患者苏醒时间长[2]。……