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目的探讨分析乌司他丁联合碳酸氢钠治疗急性辛硫磷农药中毒的临床应用价值。方法选取2012年10月至2015年12月收治洛阳市第三人民医院的急性辛硫磷农药中毒患者64例为治疗组,同期患者70例为对照组。2组患者均给予吸氧、导泻、利尿、补液以及长托宁和氯解磷定治疗。治疗组在上述措施基础上,采用2%碳酸氢钠溶液洗胃,并给予5%碳酸氢钠注射液和乌司他丁治疗。比较2组患者全血胆碱酯酶活力、长托宁和氯解磷定用量以及长托宁化时间,并对血气分析结果进行探讨。结果治疗组第1、5、10d全血胆碱酯酶活力分别为(414.8±46.2)IU/L、(534.8±54.6)IU/L、(2975.7±226.9)IU/L;而对照组分别为(412.6±49.5)IU/L、(493.7±57.2)IU/L、(2739.6±259.3)IU/L。2组胆碱酯酶活力比较,第1天时无显著差异(P>0.05),但治疗组第5、10d均显著优于对照组(P<0.05),差异有统计学意义。2组患者长托宁化时间无显著差异(P>0.05),治疗组长托宁和氯解磷定用量以及血气分析结果均优于对照组(P<0.05),差异有统计学意义。结论对于急性辛硫磷农药中毒,酸氢钠联合乌司他丁辅助治疗有助于快速恢复胆碱酯酶活力,提高临床效果。
Objective To investigate the clinical value of ulinastatin combined with sodium bicarbonate in the treatment of acute phoxim pesticide poisoning. Methods Sixty-four patients with acute phoxim pesticide poisoning from the Third People’s Hospital of Luoyang City between October 2012 and December 2015 were selected as the treatment group and 70 patients as the control group during the same period. Patients in both groups were given oxygen, catharsis, diuresis, rehydration and treatment with penehyclidine and chlorpheniramine. The treatment group based on the above measures, gastric lavage with 2% sodium bicarbonate solution, and given 5% sodium bicarbonate injection and ulinastatin treatment. The blood choline esterase activity, penehyclidine hydrochloride, chlorophyll a and peptone in the two groups were compared, and the results of blood gas analysis were also discussed. Results The whole blood cholinesterase activities in the treatment group were (414.8 ± 46.2) IU / L, (534.8 ± 54.6) IU / L and (2975.7 ± 226.9) IU / L on the 1st, (412.6 ± 49.5) IU / L, (493.7 ± 57.2) IU / L, (2739.6 ± 259.3) IU / L. There was no significant difference in the activity of cholinesterase between the two groups on the first day (P> 0.05), but the difference was statistically significant at the 5th and 10th day in the treatment group (P <0.05). There was no significant difference between the two groups (P> 0.05). The amount of topiramate and chlorophenanthroline in treatment group and blood gas analysis results were better than the control group (P <0.05), the difference was statistically significant. Conclusion Acute phoxim pesticide poisoning, sodium bicarbonate and ulinastatin adjuvant therapy help to quickly restore the cholinesterase activity, improve the clinical effect.