阿托品联合连续静脉-静脉血液滤过及血液灌流治疗老年急性重症有机磷中毒的临床分析

Clinical analysis of atropine combined with continuous veno-venous hemofiltration and hemoperfusion in the treatment of acute severe organophosphate poisoning in the elderly

中文关键词: 老年  急性重症有机磷中毒  阿托品  连续静脉—静脉血液滤过  血液灌流

英文关键词: elderly  acute severe organophosphorus poisoning  atropine  continuous veno-venous hemofiltration  hemoperfusion

中文摘要:

      目的 分析老年急性重症有机磷中毒患者接受阿托品联合连续静脉-静脉血液滤过(CVVH)+血液灌流(HP)治疗方案的疗效.方法 回顾性选取2019 年1 月—2022 年1 月于自贡市第一人民医院救治的老年急性重症有机磷中毒患者64 例,根据不同救治方案将患者分为使用阿托品救治的对照组(32 例)和使用阿托品联合CVVH+HP方案救治的观察组(32 例).2 组均接受反复清洗胃部、甘露醇或硫酸镁导泻、大量吸氧、平衡电解质、应用胆碱酯酶复能剂氯磷定等常规急救措施,此外,对照组使用阿托品救治,观察组使用阿托品联合CVVH+HP方案救治.观察并比较2 组恢复情况、胆碱酯酶(ChE)水平、心肝肾等脏器功能损伤程度评估值[心功能指标值:心肌肌钙蛋白 I(cTnI)、心肌肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB);肝功能指标值:丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST);肾功能指标值:尿蛋白定量、尿素氮、血肌酐)];评估并比较2 组机体氧化应激程度[人过氧化脂质(LPO)、丙二醛(MDA)、超氧化物歧化酶(SOD)水平]、局部炎症情况[白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、降钙素原(PCT)水平]、不良事件、临床疗效以及缓解期严重并发症发生情况.结果 与对照组比较,观察组患者清醒时间、机械通气时间、ChE活性恢复正常时间和住院时间均明显缩短,差异均有统计学意义(P＜0.05).治疗后,2 组ChE水平均高于同组治疗前,且观察组ChE水平高于对照组,差异均有统计学意义(P＜0.05).治疗后,2 组患者CK-MB、cTnI、cTnT、ALT、AST、尿蛋白定量、尿素氮、血肌酐水平均低于同组治疗前,观察组均低于对照组,差异均有统计学意义(P＜0.05).治疗后,2 组患者LPO和MDA水平均低于同组治疗前,而SOD水平高于同组治疗前;观察组LPO和MDA水平均低于对照组,而SOD水平高于对照组,差异均有统计学意义(P＜0.05).治疗后,2 组患者IL-1β、IL-6、PCT水平均低于同组治疗前,且观察组IL-1β、IL-6、PCT水平均低于对照组,差异均有统计学意义(P＜0.05).与对照组比较,观察组治疗不良事件发生率降低,而疗效升高,差异均有统计学意义(P＜0.05).与对照组比较,观察组IMS、反跳等严重并发症发生率降低,但 2 组差异无统计学意义(P＞0.05).结论 阿托品联合CVVH+HP方案可降低老年急性重症有机磷中毒患者相关并发症的发生,促进ChE表达,抑制局部炎症,增强抗氧化能力,减少对脏器功能的损害,疗效较好,具有一定的临床应用价值.

英文摘要:

      Objective To analyze the effects of atropine combined with continuous veno-venous hemofiltration(CVVH)and hemoperfusion(HP)in the treatment of acute severe organophosphate poisoning in the elderly.Methods 64 elderly pa-tients with acute severe organophosphorus poisoning treated in First People's Hospital of Zigong City from January 2019 to Janu-ary 2022 were retrospectively selected.According to different treatment plans,they were divided into control group(32 cases,treated with atropine)and observation group(32 cases,treated with atropine combined with CVVH+HP regimen).Both groups received routine first aid measures such as repeated cleaning of the stomach,induction of diarrhea with mannitol or mag-nesium sulfate,extensive oxygen inhalation,electrolyte balance,and use of cholinesterase(ChE)reactivator pralidoxime chlo-ride.In addition,the control group was treated with atropine,and the observation group was treated with atropine combined CVVH+HP.The recovery condition,the ChE level,and the evaluation values of the degree of cardiac,liver and kidney func-tion injury[cardiac function indexes:cardiac troponin I(cTnI),cardiac troponin T(cTnT),creatine kinase isoenzyme(CK-MB);liver function indexes:alanine aminotransferase(ALT),aspartate aminotransferase(AST);renal function inde-xes:urinary protein quantification,urea nitrogen,blood creatinine)]of the two groups were observed and compared.The de-gree of oxidative stress[the levels of human lipid peroxide(LPO),malondialdehyde(MDA),superoxide dismutase(SOD)],local inflammation[the levels of interleukin-1β(IL-1β),interleukin-6(IL-6),procalcitonin(PCT)],as well as adverse events,clinical efficacy and incidence of severe complications during remission of the two groups were observed and compared.Results Compared with the control group,the awake time,mechanical ventilation time,ChE activity recovery time and hospitalization time of the observation group were significantly shortened(P＜0.05).After treatment,the ChE level of the two groups was higher than that of the same group before treatment,and the observation group was higher than the con-trol group,with statistical significance(P＜0.05).After treatment,the levels of CK-MB,cTnI,cTnT,ALT,AST,urine protein,urea nitrogen,and blood creatinine of the two groups were lower than those of the same group before treatment,and the observation group were lower than the control group,with statistical significance(P＜0.05).After treatment,the levels of LPO and MDA of the two groups were lower than those of the same group before treatment,while the level of SOD of the two groups was higher than that of the same group before treatment;the improvement amplitude of above indexes of the observation group were greater than that of the control group(P＜0.05).After treatment,the levels of IL-1β、IL-6 and PCT were lower than those of the same group before treatment,and the observation group were significantly lower than the control group(P＜0.05).Compared with the control group,the incidence of adverse events in the observation group decreased,while the effica-cy increased,and the differences were statistically significant(P＜0.05).Compared with the control group,the incidence of severe complications such as IMS and rebound decreased in the observation group,but there was no statistical significance be-tween the two groups(P＞0.05).Conclusion The combination of atropine and CVVH+HP regimen can reduce the occur-rence of related complications in elderly patients with acute severe organophosphorus poisoning,promote the expression of ChE,inhibit local inflammation,enhance antioxidant capacity,and reduce the damage to organ functions.It has a good thera-peutic effect and certain clinical application value.