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目的探讨血液灌流(hemoperfusion,HP)对重度急性有机磷农药中毒(AOPP)中间综合征(IMS)的发生及预后的影响。方法对界首市医院收治的98例重度AOPP患者随机分为HP组(n=49)和对照组(n=49),HP组在氯磷定、盐酸戊乙奎醚(长托宁,Penehyclidime hydrochloride,PHC)及综合治疗的基础上加HP,对照组仅解毒及综合治疗;分别对IMS的发生率、机械通气时间、长托宁的用量、血清胆碱酯酶(ChE)和治愈率进行分析。结果两组IMS发生率为HP组42.8%,对照组44.9%,相比差异无统计学意义(P>0.05)。两组甲拌磷农药中毒IMS发生率分别为58.8%和65.6%,远高于其他种类有机磷(OP)IMS平均数6.2%。两组机械通气时间、长托宁用量、ChE恢复时间和治愈率差异无统计学意义(P>0.05)。结论HP不能降低重度AOPP患者IMS发生率及病死率,IMS与OP种类有相关性。
Objective To investigate the effect of hemoperfusion (HP) on the occurrence and prognosis of severe acute organophosphorus pesticide poisoning (AOPP) intermediate syndrome (IMS). Methods Ninety-eight patients with severe AOPP admitted to Jieshou City Hospital were randomly divided into HP group (n = 49) and control group (n = 49). HP group was treated with chlorpromazine, penehyclidine hydrochloride (HPC), detoxification and combination therapy on the basis of comprehensive treatment, respectively. The incidence of IMS, the duration of mechanical ventilation, the amount of penehyclidine, the serum ChE and the cure rate analysis. Results The incidence of IMS in the two groups was 42.8% in the HP group and 44.9% in the control group, with no significant difference (P> 0.05). The incidence of IMS in both pesticides was 58.8% and 65.6%, respectively, much higher than the average of 6.2% for other species of organic phosphorus (OP) IMS. There was no significant difference between the two groups in the duration of mechanical ventilation, the amount of penehyclidine, the recovery time of ChE and the cure rate (P> 0.05). Conclusion HP can not reduce the incidence of IMS in severe AOPP patients and mortality, IMS and OP species are related.