【摘要】：目的:觀察血液灌流(hemoperfusion HP)聯(lián)合連續(xù)性靜脈-靜脈血液透析濾過(guò)(continuous veno-venous hemodiafiltration CVVHDF)技術(shù)治療急性重度有機(jī)磷農(nóng)藥中毒的臨床療效。方法:選取2014年01月至2016年10月期間寒亭區(qū)人民醫(yī)院重癥醫(yī)學(xué)科收治的63例急性重度有機(jī)磷農(nóng)藥中毒(acute severe organophosphorus pesticide poisoning ASOPP)患者,男性29例,女性34例,年齡14-70歲,分為研究組(HP+CVVHDF組,33例)與對(duì)照組(HP組,30例)。兩組患者在入院后均給予洗胃、導(dǎo)瀉、利尿、膽堿酯酶復(fù)能藥(氯解磷定)、膽堿受體拮抗劑(阿托品、長(zhǎng)托寧),同時(shí)給予補(bǔ)液、保護(hù)多臟器功能等對(duì)癥支持治療。對(duì)照組入院后盡早行血液灌流治療,治療時(shí)間2-3小時(shí)。研究組在對(duì)照組的基礎(chǔ)上聯(lián)合連續(xù)性靜脈-靜脈血液透析濾過(guò)治療,即血液灌流治療2-3小時(shí)后中斷治療,取下灌流器,繼續(xù)予以連續(xù)性靜脈-靜脈血液透析濾過(guò)治療,治療時(shí)間24-48小時(shí)。血液灌流雖可快速清除患者體內(nèi)的有機(jī)磷農(nóng)藥,但是容易造成患者內(nèi)環(huán)境的紊亂,加重腦水腫及其他臟器的損害。而連續(xù)性靜脈-靜脈血液透析濾過(guò)技術(shù)幾乎不改變患者的血漿滲透壓,血流動(dòng)力學(xué)穩(wěn)定,可以調(diào)節(jié)患者的容量,并且保持機(jī)體的酸堿和電解質(zhì)平衡,既能夠持續(xù)而有效的清除毒素、避免毒素反跳,又能夠清除炎癥介質(zhì),以避免不可逆的多器官組織損傷,但通常被認(rèn)為需要高額的治療費(fèi)用。本研究中采用血液灌流聯(lián)合連續(xù)性靜脈-靜脈血液透析濾過(guò)的血液凈化技術(shù)就是利用二者優(yōu)勢(shì)互補(bǔ)的特點(diǎn),觀察兩組患者的衛(wèi)生經(jīng)濟(jì)學(xué)指標(biāo):昏迷時(shí)間、機(jī)械通氣時(shí)間、血漿炎性因子的水平(腫瘤壞死因子-α、白細(xì)胞介素-1β、白細(xì)胞介素-6、白細(xì)胞介素-8)、平均住ICU天數(shù)、平均住ICU費(fèi)用及臨床治愈率。結(jié)果:兩組患者之間的昏迷時(shí)間、機(jī)械通氣時(shí)間、臨床治愈率、平均住ICU天數(shù)、平均住ICU費(fèi)用相比較,差異有統(tǒng)計(jì)學(xué)意義(均p0.05);兩組患者血漿炎性因子的水平(腫瘤壞死因子-α、白細(xì)胞介素-1β、白細(xì)胞介素-6、白細(xì)胞介素-8)治療前后比較,差異有統(tǒng)計(jì)學(xué)意義(p0.05),研究組治療后與對(duì)照組比較,差異有統(tǒng)計(jì)學(xué)意義(p0.05)。結(jié)論:采用血液灌流(hemoperfusion HP)聯(lián)合連續(xù)性靜脈-靜脈血液透析濾過(guò)(continuous veno-venous hemodiafiltration CVVHDF)技術(shù)治療急性重度有機(jī)磷農(nóng)藥中毒患者在清除機(jī)體血漿內(nèi)炎性因子因子方面具有獨(dú)特的優(yōu)勢(shì),可以顯著縮短昏迷時(shí)間及機(jī)械通氣時(shí)間,提高臨床治愈率,減少在ICU的住院天數(shù)和治療費(fèi)用,臨床療效顯著,是一種安全、經(jīng)濟(jì)、有效的雜合血液凈化方法。
[Abstract]:Objective: to observe the clinical effect of hemoperfusion (hemoperfusion HP) combined with continuous veno-venous hemodiafiltration (continuous veno-venous hemodiafiltration CVVHDF) in the treatment of acute severe organophosphorus pesticide poisoning. Methods: from January 2014 to October 2016, 63 patients with acute severe organophosphorus pesticide poisoning (acute severe organophosphorus pesticide poisoning ASOPP), male 29, female 34, aged 14-70 years, were selected from Department of intensive Medicine, people's Hospital of Hanting District. They were divided into study group (HP CVVHDF group, n = 33) and control group (HP group, n = 30). Both groups were treated with gastric lavage, catharsis, diuretic, cholinesterase reactivity (chlorophosphamide), choline receptor antagonist (atropine, Changtonin), rehydration, protection of multiple organ function, etc. The control group received hemoperfusion therapy as soon as possible after admission for 2-3 hours. On the basis of the control group, the study group combined with continuous veno-venous hemodiafiltration therapy, that is, after 2-3 hours of hemoperfusion therapy, the treatment was interrupted, the perfusion device was removed, and the continuous veno-venous hemodiafiltration therapy was continued. Treatment time was 24-48 hours. Although hemoperfusion can quickly remove organophosphorus pesticides from patients, it is easy to cause disorder in patients' internal environment and aggravate brain edema and other organ damage. Continuous veno-venous hemodiafiltration has little effect on plasma osmotic pressure, stable hemodynamics, adjusts the volume of the patient, and maintains the balance of acid, base and electrolyte. It can remove toxins continuously and effectively, avoid toxin bouncing, and remove inflammatory mediators to avoid irreversible multiple organ and tissue damage, but it is usually considered to require high cost of treatment. In this study, hemoperfusion combined with continuous veno-venous hemodiafiltration was used to observe the health economic indexes of the two groups: coma time, mechanical ventilation time. The levels of plasma inflammatory factors (tumor necrosis factor- 偽, interleukin-1 尾, interleukin-6, interleukin-8), the average number of days of living in ICU, the average cost of living in ICU and the clinical cure rate. Results: the time of coma, the time of mechanical ventilation, the clinical cure rate, the average days of living in ICU, the average cost of living in ICU were compared between the two groups. The levels of plasma inflammatory factors (tumor necrosis factor- 偽, interleukin-1 尾, interleukin-6, interleukin-8) were compared between the two groups before and after treatment. The difference was statistically significant (p0.05), compared with the control group after treatment (p0.05). Conclusion: hemoperfusion with (hemoperfusion HP) combined with continuous veno-venous hemodiafiltration (continuous veno-venous hemodiafiltration CVVHDF) has a unique advantage in removing plasma inflammatory factors in patients with acute severe organophosphorus pesticide poisoning. It can significantly shorten the time of coma and mechanical ventilation, increase the clinical cure rate, reduce the days of hospitalization and the cost of treatment in ICU. It is a safe, economical and effective method of blood purification for hybrids.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R595.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 由麗麗;;局部枸櫞酸抗凝法在重癥患者連續(xù)性腎臟替代治療中的應(yīng)用研究[J];海南醫(yī)學(xué)院學(xué)報(bào);2016年23期

2 楊靜;白智遠(yuǎn);;局部枸櫞酸抗凝在連續(xù)性腎臟替代治療中的應(yīng)用研究進(jìn)展[J];臨床合理用藥雜志;2016年06期

3 王穎;張寧;高雯;;不同血液凈化方式治療重度急性有機(jī)磷農(nóng)藥中毒臨床觀察[J];內(nèi)蒙古醫(yī)科大學(xué)學(xué)報(bào);2015年05期

4 王婷立;付平;;枸櫞酸抗凝在連續(xù)腎臟替代治療中的應(yīng)用方法和監(jiān)測(cè)[J];中國(guó)血液凈化;2015年09期

5 梁蘭玉;趙翔宇;殷安康;董世童;苗潤(rùn)豐;;中西醫(yī)結(jié)合治療90例急性重度有機(jī)磷農(nóng)藥中毒臨床分析[J];亞太傳統(tǒng)醫(yī)藥;2015年14期

6 鮑江波;劉艷姝;杜娟;馬艷芳;王艷秋;;連續(xù)性血液凈化對(duì)SIRS/SEPSIS合并急性腎衰患者血清PCT、TNF-α、IL-6、IL-10等炎癥因子水平的影響[J];中國(guó)醫(yī)學(xué)創(chuàng)新;2015年16期

7 黃建;王曉艷;;血液灌流聯(lián)合血液濾過(guò)對(duì)有機(jī)磷農(nóng)藥中毒患者療效及炎癥狀態(tài)的影響[J];重慶醫(yī)學(xué);2015年15期

8 謝敏丹;陳海麗;林肖琴;張近波;;早期連續(xù)性腎替代治療對(duì)重癥急性胰腺炎患者急性肺損傷的影響[J];中國(guó)基層醫(yī)藥;2015年07期

9 王大芳;;血淀粉酶和C反應(yīng)蛋白在有機(jī)磷中毒早期診斷中的臨床意義[J];中國(guó)實(shí)驗(yàn)診斷學(xué);2014年05期

10 宋先榮;丁付燕;王曉航;韓宇;程兆云;劉富榮;;雜合血液凈化技術(shù)在心臟外科術(shù)后的應(yīng)用[J];心血管外科雜志(電子版);2014年01期

，

本文編號(hào)：2194104