本文選題：有機(jī)磷中毒 + 血液灌流　； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：目的分析血液灌流(hemoperfusion HP)對重度急性有機(jī)磷農(nóng)藥重度中毒(AOPP)治療效果方法:入選病例為2008年9月至2011年9月在我院住院的重度AOPP患者82例(剔除自行終止治療或轉(zhuǎn)院),灌流組(HP組)為入院接受了灌流治療,非灌流組(非HP組)為入院后沒有接受灌流治療,非HP組按常規(guī)予積極洗胃,導(dǎo)瀉,催吐,并予阿托品及解磷定治療。HP組在上述治療基礎(chǔ)上同時加用HP治療,觀察全部病例的農(nóng)藥服用量,患者的一般情況、中毒藥物類型,首診時間,初診時膽堿酯酶(CHE)活力,血肌酐、動脈血氧分壓和病死率,急性呼吸衰竭的發(fā)生率。觀察存活病例:CHE恢復(fù)時間,并評估兩組病人在治療過程中阿托品化時間、到達(dá)阿托品化時阿托品的用量、氯磷定用量、病程中阿托品的總量及中間綜合征(IMs)發(fā)生率、機(jī)械通氣時間、APACHEII評分、血液灌流引起的并發(fā)癥,并記錄全部患者的住院天數(shù),以上數(shù)據(jù)評價HP搶救有機(jī)磷農(nóng)藥中毒的效果。記錄HP組患者HP前后血紅蛋白(HB)濃度,白細(xì)胞(WBC),血小板(PIT)數(shù)、纖維蛋白原(metaglobulin)水平來判斷HP對血細(xì)胞成分和凝血系統(tǒng)的影響;記錄HP治療過程中第10分鐘,60分鐘,120分鐘的平均動脈壓和其他不良反應(yīng)。以住院死亡為觀察終點(diǎn),觀察影響患者預(yù)后的危險因素,同時觀察血液灌流組患者與HP相關(guān)的并發(fā)癥。結(jié)果:非HP組與HP組比較,性別、農(nóng)藥服用量、中毒農(nóng)藥類型無差異(P0.05;)。兩組患者呼吸衰竭發(fā)生率、中毒到開始搶救時間、入院時膽堿酯酶活力比較差異均無統(tǒng)計學(xué)意義(P0.05)。與非HP組比較,HP組患者阿托品化時間[(4.54±0.9)hVS(5.24±0.8)h]、血清膽堿酯酶恢復(fù)正常時間[(9.54±1.1)d VS(11.3±1.5)d]、住院時間[(10.5±1.2)d VS(13.44±2.1)d]均縮短,阿托品化量[(262.1±29.7)mgVS(294.8±31.6)mg]降低,差異有統(tǒng)計學(xué)意義(P0.05)。中間綜合征發(fā)生率[12.2%(5/41)VS19.5%(8/41)]、機(jī)械通氣時間[(4.06±0.68)dVS(5.01±0.60)d]、阿托品總量[(801.9±91.4)mg VS(974.4±87.3)mg]明顯降低(P0.01),兩組之間氯磷定用量HP組(17.89±5.98)VS非HP組(21.75±6.22)差異有統(tǒng)計學(xué)意義(P0.05)。死亡危險因素分析:死亡組VS存活組在年齡(58.6±17.3)VS(42.8±12.5)、農(nóng)藥服用量(188.7±28)VS(78.9±32.7)、初始膽堿酯酶活力(235±55.4)VS(809.2±588.9)、并發(fā)癥、APACHEII評分(18.8±9.9)VS(7.9±6.3)與患者的預(yù)后密切相關(guān)(P0.01),HP可能影響預(yù)后。HP前后HB濃度無顯著變化(P0.05)。HP對血壓、白細(xì)胞(14.7±5.1)VS(12.6±4.8)、血小板(208±43.9)VS(179±55.4)、纖維蛋白原(2.85±1.15)VS(3.38± 1.26)有影響(P0.05)。結(jié)論:1.HP能減少阿托品用量、縮短阿托品化時間、縮短膽堿酯酶恢復(fù)時間、縮短住院時間。2.HP可明顯減少AOPP患者IMS的發(fā)生率,縮短機(jī)械通氣時間。3.HP對血壓及血液部份成份有少許影響,但不影響治療。
[Abstract]:Objective to analyze the therapeutic effect of hemoperfusion HPP on severe acute organophosphorus pesticide poisoning (AOPP). 82 patients with severe AOPP who were hospitalized in our hospital from September 2008 to September 2011 were selected. The hospital, the perfusion group (HP group) was admitted to the hospital to receive perfusion treatment, The non-perfusion group (non-HP group) did not receive perfusion therapy after admission, and the non-HP group was treated with active gastric lavage, catharsis, emesis, atropine and alophosphamide treatment. The HP group was treated with HP on the basis of the above mentioned treatment at the same time. The dosage of pesticide, the general condition of the patients, the type of poisoning drugs, the time of first visit, the activity of cholinesterase (che), the blood creatinine, the partial pressure of oxygen in arterial blood, the death rate and the incidence of acute respiratory failure were observed. To observe the recovery time of surviving case: che, and to evaluate the time of atropinization during treatment, the dosage of atropine, the dosage of chlorophosphoridine, the total amount of atropine during the course of the disease and the incidence of intermediate syndrome (IMs). The mechanical ventilation time, Apache II score, complications caused by hemoperfusion, and the days of hospitalization of all patients were recorded. The above data were used to evaluate the efficacy of HP in rescuing organophosphorus pesticide poisoning. In HP group, the concentration of HB and HBs, the number of WBCU, the number of platelet PITs and the level of fibrinogen were recorded to determine the effect of HP on blood cell composition and coagulation system. The mean arterial pressure and other adverse reactions were recorded at 10 min, 60 min and 120 min during HP treatment. The end point of inpatient death was observed to observe the risk factors affecting the prognosis of the patients and the HP related complications in the hemoperfusion group were observed. Results: there was no difference in sex, dosage of pesticide and type of toxic pesticide between non HP group and HP group (P 0. 05). The incidence of respiratory failure, the time from poisoning to the beginning of rescue, and the difference of cholinesterase activity between the two groups were not statistically significant (P 0.05). Compared with the non-HP group, the atropinization time [4.54 鹵0.9hVSU 5.24 鹵0.8h], the serum cholinesterase recovery time [9.54 鹵1.1 days vs 11.3 鹵1.5 days], the hospitalization time [10.5 鹵1.2 days vs 13.44 鹵2.1 days] and the atropine volume (262.1 鹵29.7mgVS294.8 鹵31.6)mg) were significantly decreased. The incidence of intermediate syndrome [12.2v / 41VS19.5V = 8 / 41], mechanical ventilation time (4.06 鹵0.68dVS5.01 鹵0.60g / d), total atropine [801.9 鹵91.4)mg VSN 974.4 鹵87.3)mg] significantly decreased P0.01.The difference between the two groups was significant (P 0.05). There was a significant difference between the HP group and the HP group (17.89 鹵5.98 vs + 21.75 鹵6.22). Analysis of the risk factors of death: the age of vs survival group was 58.6 鹵17.3VSN 42.8 鹵12.5m, the dosage of pesticide was 188.7 鹵28VSN 78.9 鹵32.7m, the initial cholinesterase activity was 235 鹵55.4VSn 809.2 鹵588.9, the Apache II score was 18.8 鹵9.9VSv 7.9 鹵6.3) and the prognosis of patients was closely related to the prognosis (P0.01P). There was no significant change in HB concentration before and after HP (P 0.05.HP). WBC: 14.7 鹵5.1VSN 12.6 鹵4.8m, platelets 208 鹵43.9VSN 179 鹵55.4U, fibrinogen 2.85 鹵1.15VSN 3.38 鹵1.26). Conclusion: 1. HP can reduce the dosage of atropine, shorten the time of atropinization, shorten the time of cholinesterase recovery, and shorten the hospitalization time. 2. HP can obviously reduce the incidence of IMS in AOPP patients. Shortening mechanical ventilation time. 3. HP has a little effect on blood pressure and blood components, but does not affect treatment.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R595.4

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