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目的:探讨急性重度有机磷农药中毒(acute severe organophosphorus pesticide poisoning,ASOP)的临床特点及救治体会。方法:将符合ASOP诊断标准的114例患者依抢救措施的不同而分为常规组及治疗组,常规组予常规内科综合治疗,治疗组在常规治疗的基础上行血液透析(HD)联合血液灌流(HP)治疗。比较两组的治疗效果。结果:常规组的治愈率为62.2%,治疗组的治愈率为88.5%,两组之间差异显著(P<0.01)。治疗组的平均动脉压、脉搏血氧饱和度、心率、胆碱酯酶活性改善程度均显著优于常规组,昏迷时间、机械通气时间、平均住院日均显著低于常规组(P<0.01)。治疗组仅1例发生反跳现象,而常规组发生中间综合征12例,反跳现象9例,迟发性周围神经病变4例。结论:在常规内科综合治疗的基础上行血液灌流联合血液透析可显著提高ASOP患者的救治成功率,减少迟发性病变的发生率,值得临床上推广使用。
Objective: To investigate the clinical features and treatment of acute severe organophosphorus pesticide poisoning (ASOP). Methods: One hundred and seventy-four patients who met ASOP diagnostic criteria were divided into routine group and treatment group according to the different rescue measures. The conventional group was given general medical treatment. The treatment group was treated with hemodialysis (HD) combined with hemoperfusion HP) treatment. Compare the treatment effect of two groups. Results: The cure rate of the conventional group was 62.2%, and the cure rate of the treatment group was 88.5%. There was significant difference between the two groups (P <0.01). The mean arterial pressure, pulse oximetry, heart rate and cholinesterase activity in the treatment group were significantly better than those in the conventional group. The coma time, mechanical ventilation time and average length of stay were significantly lower than those in the conventional group (P <0.01) . In the treatment group, only one patient rebound phenomenon, while the conventional group occurred in 12 cases of intermediate syndrome, rebound phenomenon in 9 cases, delayed peripheral neuropathy in 4 cases. Conclusion: Hemoperfusion combined with hemodialysis can significantly improve the success rate of treatment and reduce the incidence of delayed-onset lesions in ASOP patients on the basis of conventional medical comprehensive treatment, which is worth popularizing in clinic.