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目的:探讨血液灌流辅助治疗急性重度有机磷农药中毒的临床效果。方法:将广州新海医院肾内科和广东医学院附属厚街医院肾内科2010年4月-2014年10月收治的急性重度有机磷农药中毒患者62例根据家属意见分为观察组30例和对照组32例,对照组按急性重度有机磷农药中毒的常规治疗和护理,观察组在对照组治疗的基础上联合血液灌流治疗,比较两组病例的治愈率、阿托品用量、昏迷到清醒的时间、血液灌流前后全血胆碱酯酶水平的变化。结果:观察组的治愈率90.0%(27/30)与对照组的89.6%(28/32)无明显差异(P>0.05),观察组和对照组阿托品的总用量、昏迷至清醒的时间分别为(97.2±36.3)mg、(398.4±118.3)mg和(11.6±7.6)h、(29.2±11.2)h,差异有统计学意义(P均<0.05),观察组血液灌流后的全血胆碱酯酶水平(1184.4±386.2)U/L显著高于血液灌流前的(576.1±522.3)U/L(P<0.01),且明显高于对照组同时间点的全血胆碱酯酶水平(728.7±481.2)U/L(P<0.05)。结论在急性重度有机磷农药中毒常规药物治疗的基础上,联合使用血液灌流治疗的临床效果更好,有条件时应及早应用。
Objective: To investigate the clinical effect of hemoperfusion on acute severe acute organophosphorus pesticide poisoning. Methods: 62 patients with acute severe organophosphorus pesticide poisoning admitted to Department of Nephrology, Xinhai Hospital of Guangzhou and Houjie Hospital Affiliated to Guangdong Medical College from April 2010 to October 2014 were divided into observation group (30 cases) and control group 32 cases in the control group were treated by routine treatment and nursing of acute severe organophosphorus pesticide poisoning. The observation group was treated with hemoperfusion on the basis of the control group. The cure rate, the amount of atropine, the amount of atropine, the time from coma to awake, Changes of whole blood cholinesterase levels before and after perfusion. Results: The cure rate of the observation group was 90.0% (27/30) and 89.6% (28/32) of the control group had no significant difference (P> 0.05). The total amount of atropine in the observation group and the control group, coma to awake time (97.2 ± 36.3) mg, (398.4 ± 118.3) mg and (11.6 ± 7.6) h, (29.2 ± 11.2) h respectively, the difference was statistically significant (all P <0.05) The level of alkaline esterase (1184.4 ± 386.2) U / L was significantly higher than that before hemodialysis (576.1 ± 522.3) U / L (P <0.01) and was significantly higher than that of the control group (728.7 ± 481.2) U / L (P <0.05). Conclusion On the basis of conventional drug treatment of acute severe organophosphorus pesticide poisoning, the clinical effect of combined hemoperfusion is better and should be applied as soon as possible.