本文選題：急性重度有機磷中毒　切入點：血液灌流　出處：《青島大學(xué)》2017年碩士論文

【摘要】：目的:觀察不同血液灌流(hemoperfusion,HP)模式聯(lián)合持續(xù)腎臟替代治療(continuous renal replacement therapy,CRRT)在治療急性重度有機磷農(nóng)藥中毒(acute severe organophosphorus pesticide poisoning,ASOPP)患者中的臨床療效。方法:選取2014年12月至2017年02月期間在泰山醫(yī)學(xué)院附屬青州醫(yī)院收治的63例ASOPP患者為研究對象,隨機分為加強組(30例)和常規(guī)組(33例),兩組患者入院后均立即給予一般治療,包括洗胃、應(yīng)用常規(guī)藥物,均在一般治療的基礎(chǔ)上采用不同模式的HP+CRRT治療。根據(jù)患者意識情況和血氣分析情況,決定是否給于經(jīng)口氣管插管應(yīng)用呼吸機輔助呼吸,出現(xiàn)呼吸、心跳驟停病人,即刻行心肺復(fù)蘇術(shù)。常規(guī)組應(yīng)用HP每天1次,每次2h,連續(xù)3 d。加強組應(yīng)用HP第1天每8h進(jìn)行1次,每次2h,第2天每12h進(jìn)行1次,每次2h,第3天只進(jìn)行1次,持續(xù)2h。采用SPSS 19.0軟件包進(jìn)行統(tǒng)計學(xué)分析,計量資料數(shù)據(jù)以x±s表示,組間比較采用t檢驗,治療不同時期膽堿酯酶活力數(shù)據(jù)分析采用重復(fù)測量方差分析,計數(shù)數(shù)據(jù)采用X2檢驗,以P0.05為有顯著性。比較兩組患者的一般情況、中毒至治療開始時間、治療前APACHEII評分、常規(guī)藥物用量,生化指標(biāo)、膽堿酯酶活力、出現(xiàn)呼吸衰竭例數(shù)、通氣時間、住院天數(shù)、出現(xiàn)并發(fā)癥情況和死亡率等。并對死亡患者和存活患者服毒劑量、APACHEII評分、中毒至治療時間、膽堿酯酶活力進(jìn)行比較,初步分析患者死亡的影響因素。結(jié)果:兩組患者在性別、年齡、中毒藥物、中毒量和中毒至搶救時間方面差異均無統(tǒng)計學(xué)意義(P0.05),具有可比性。加強組患者常規(guī)藥物的用量均顯著小于常規(guī)組(P0.05),通氣時間和住院時間均顯著小于常規(guī)組(P0.01)。兩組患者治療前膽堿酯酶活力無統(tǒng)計學(xué)差異(P0.05),加強組治療3d和治療5d的膽堿酯酶活力顯著高于常規(guī)組(P0.01)。加強組患者除呼吸衰竭外并發(fā)癥發(fā)生率、死亡率均顯著低于常規(guī)組(P0.05)。死亡患者服毒劑量、APACHEII評分、中毒致洗胃時間死亡患者顯著高于存活患者(P0.05)。結(jié)論:加強HP+CRRT模式治療ASOPP患者,有利于減少常規(guī)藥物用量,縮短通氣時間和住院時間,加快膽堿酯酶活力恢復(fù)速度,減少并發(fā)癥,降低病死率。服毒劑量、APACHEⅡ評分、救治時間、膽堿酯酶活力可能是患者死亡的影響因素,治療時應(yīng)給予重視。意義:血液凈化目前是治療中毒患者的一種有效措施,在治療ASOPP患者中HP+CRRT的次數(shù)對最終的臨床結(jié)局的影響研究很少,日常臨床工作中多數(shù)以經(jīng)驗性治療為主,本研究結(jié)果顯示加強HP+CRRT模式是一種安全、有效的治療方案,且簡便易行,值得基層醫(yī)院推廣應(yīng)用。
[Abstract]:Methods: from December 2014 to February 2017, 63 patients with ASOPP in Qingzhou Hospital affiliated to Taishan Medical College were randomly divided into two groups: strengthening group (n = 30) and routine group (n = 33). The patients in both groups were given general treatment immediately after admission.Both gastric lavage and routine drugs were treated with HP CRRT on the basis of general treatment.According to the patient's consciousness and blood gas analysis, it was decided whether to apply ventilator to the tracheal intubation, breathing, cardiac arrest, cardiopulmonary resuscitation.The routine group was treated with HP once a day for 2 hours for 3 days.In the strengthening group, HP was given once every 8 hours on the first day, once every 12 hours on the second day, and only once every 2 hours on the third day for 2 hours.The statistical analysis was carried out by SPSS 19.0 software package. The measurement data were expressed as x 鹵s. T test was used to compare the cholinesterase activity among groups, the repeated measurement analysis of variance was used to analyze the cholinesterase activity data in different treatment periods, and the X2 test was used to count the data.In order to P0.05 as significant.The general condition of the two groups, the time of poisoning to the beginning of treatment, the APACHEII score before treatment, the dosage of routine drugs, biochemical indexes, cholinesterase activity, the number of cases of respiratory failure, the time of ventilation, the days of hospitalization, the general condition of the two groups were compared.Complications and mortality.The APACHEII score, time from poisoning to treatment, cholinesterase activity were compared between the dead patients and the surviving patients, and the influencing factors of the patients' death were analyzed.Results: there was no significant difference between the two groups in sex, age, poisoning drug, poisoning amount and time from poisoning to rescue.The dosage of routine drugs in the strengthening group was significantly lower than that in the routine group, and the ventilation time and hospitalization time were significantly lower than that in the routine group.There was no significant difference in cholinesterase activity between the two groups before treatment. The cholinesterase activity in the strengthening group was significantly higher than that in the control group on the 3rd day and 5th day.The incidence of complications and mortality in the strengthening group were significantly lower than those in the routine group except respiratory failure (P 0.05).APACHEII score was significantly higher in the dead patients than in the surviving patients (P 0.05).Conclusion: the enhancement of HP CRRT model in the treatment of ASOPP patients is beneficial to reduce the dosage of conventional drugs, shorten the time of ventilation and hospitalization, accelerate the recovery of cholinesterase activity, reduce complications and reduce the mortality.APACHE 鈪，

本文編號：1722823