本文選題：血液凈化 + 急性重度有機(jī)磷農(nóng)藥中毒　； 參考：《第四軍醫(yī)大學(xué)》2016年碩士論文

【摘要】：目的有機(jī)磷農(nóng)藥在我國(guó)應(yīng)用廣泛,是常見的中毒原因。傳統(tǒng)治療對(duì)輕中度有機(jī)磷農(nóng)藥中毒可取得理想療效,但是對(duì)重度有機(jī)磷農(nóng)藥中毒治療效果不佳。近年來,血液凈化越來越多的應(yīng)用于重度有機(jī)磷農(nóng)藥中毒,為臨床提供了更有效的救治方式。本研究對(duì)急性重度有機(jī)磷農(nóng)藥中毒患者的相關(guān)臨床資料進(jìn)行統(tǒng)計(jì)分析,探討血液灌流(hemoperfusion,HP)聯(lián)合血漿置換(plasma exchange,PE)對(duì)急性重度有機(jī)磷農(nóng)藥中毒患者的療效。方法回顧性分析2012年12月至2014年12月第四軍醫(yī)大學(xué)西京醫(yī)院急診科收治的急性重度有機(jī)磷農(nóng)藥中毒91例患者的資料,將患者分為常規(guī)治療組(CT組)33例,血液灌流組(HP組)30例及血液灌流聯(lián)合血漿置換組(HE組)28例,比較各組患者入院時(shí)的一般情況,并對(duì)臨床療效、血生化指標(biāo)、并發(fā)癥和治療前后的血清膽堿酯酶活性和炎癥因子腫瘤壞死因子-α(tumor necrosis factor-α,TNF-α)、白細(xì)胞介素-1β(interleukim-1β,IL-1β)、白細(xì)胞介素-6(interleukim-6,IL-6)、白細(xì)胞介素-8(interleukim-8,IL-8)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果各組患者入院時(shí)一般情況比較無統(tǒng)計(jì)學(xué)差異。HP組和HE組較CT組的治愈率升高,阿托品總用量、氯解磷定總用量減少,住院時(shí)間、昏迷時(shí)間縮短(P0.05),HE組的阿托品總用量、氯解磷定總用量、昏迷時(shí)間顯著低于HP組(P0.05);HE組肌酐(cratinine,Cr)、血淀粉酶(amylase,AMY)較CT組、HP組顯著下降,HE組谷丙轉(zhuǎn)氨酶(alanine amino transferase,ALT)較CT組顯著下降(P0.05),與HP組比較無統(tǒng)計(jì)學(xué)差異;HP組、HE組的膽堿酯酶活性在治療后4h、24h、72h均顯著高于CT組(P0.05),HE組的膽堿酯酶活性在治療后24h顯著高于HP組(P0.05);HP組和HE組并發(fā)癥較CT組明顯減少(P0.05);HE組炎癥因子在治療后顯著低于HP組和CT組(P0.05)。結(jié)論HP對(duì)急性重度有機(jī)磷農(nóng)藥中毒有著顯著療效,HP聯(lián)合PE可進(jìn)一步提高臨床效果,改善患者的肝腎、胰腺功能,快速升高患者的膽堿酯酶活性,減少患者的并發(fā)癥,潛在機(jī)制可能與降低患者的炎癥因子有關(guān)。但是PE治療費(fèi)用較高,在基層醫(yī)院開展存在著一定困難。
[Abstract]:Objective organophosphorus pesticide is widely used in China and is a common cause of poisoning. The effect of traditional treatment on mild and moderate organophosphorus pesticide poisoning is ideal, but it is not good for severe organophosphorus pesticide poisoning. In recent years, blood purification is more and more used in severe organophosphorus pesticide poisoning, which provides a more effective treatment for clinical treatment. In this study, the clinical data of patients with acute severe organophosphorus pesticide poisoning were statistically analyzed, and the curative effect of hemoperfusion HPX combined with plasma exchange (PEP) on patients with acute severe organophosphorus pesticide poisoning was investigated. Methods the data of 91 patients with acute severe organophosphorus pesticide poisoning treated in the emergency department of Xijing Hospital of fourth military Medical University from December 2012 to December 2014 were retrospectively analyzed. The patients were divided into routine treatment group (n = 33) and CT group (n = 33). The hemoperfusion group (HP) group (n = 30) and hemoperfusion combined plasma exchange group (n = 28) with HE group (n = 28) were compared. Serum cholinesterase activity and tumor necrosis factor- 偽 (TNF- 偽), interleukim-1 尾 (IL-1 尾), interleukin-6 (IL-6) interleukim-6 (IL-6) and interleukin-8 interleukim-8IL-8 (IL-8) were analyzed before and after treatment. Results there was no significant difference in the general condition of the patients at admission. The cure rate of HP group and HE group was higher than that of CT group. The total dosage of atropine, total dosage of chlorophosphoridine, hospitalization time and coma time were decreased, and the total dosage of atropine in HE group was shortened than that in HE group. Total dosage of phosphorylchloride, The coma time was significantly lower than that in HP group (P 0.05), and the serum amylase (AMY) was significantly lower than that in HP group (P 0.05). The activity of cholinesterase in HP group was significantly lower than that in HE group (P 0.05), and the activity of cholinesterase in HP group was not significantly different from that in HP group (P < 0.05), and the activity of cholinesterase in HP group was significantly lower than that in CT group (P < 0.05), and the activity of cholinesterase in HP group was not significantly different from that in HP group (P < 0.05). The activity of cholinesterase in the HE group was significantly higher than that in the HP group at 24 h after treatment and the complications in the HP group were significantly higher than those in the HP group and the HE group. The inflammatory factors in the HE group were significantly lower than those in the HP group and the CT group after treatment, and the activity of cholinesterase in the HE group was significantly lower than that in the HP group and CT group. Conclusion HP has significant curative effect on acute severe organophosphorus pesticide poisoning. HP combined with PE can further improve the clinical effect, improve the function of liver, kidney and pancreas, increase the cholinesterase activity rapidly, and reduce the complications of the patients. The underlying mechanism may be related to the reduction of inflammatory factors in patients. However, PE treatment costs are high, there are some difficulties in the development of primary hospitals.
【學(xué)位授予單位】：第四軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R595.4

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