摘要
目的:探讨血液灌流用于重度有机磷农药中毒的临床效果及其对患者膈肌功能的影响。方法:选取济宁医学院附属湖西医院(单县中心医院)重症医学科2018年1月至2020年1月收治的重度有机磷农药中毒患者85例为研究对象,按照随机数字表法分为治疗组43例和对照组42例,两组均给予洗胃、导泻、应用复能剂和抗胆碱药物等常规治疗,治疗组在常规治疗基础上加用3次血液灌流,每次间隔24 h。检测治疗组血液灌流前、3次血液灌流后与对照组对应时间点血清胆碱酯酶(CHE)、白细胞介素6(IL-6)、动脉血氧分压、动脉血二氧化碳分压,计算两组急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分和氧合指数(QI),床旁超声测量两组右侧膈肌活动度(DE)、吸气末膈肌厚度(DTei)、呼气末膈肌厚度(DTee),计算膈肌增厚率(DTF)和膈肌浅快呼吸指数(D-RSBI),比较两组CHE、IL-6、QI、DE、DTF、D-RSBI的差异,比较两组中间综合征发生率、气管插管率、28 d病死率及住院时间的差异。结果:血液灌流前,两组CHE、IL-6、QI、DE、DTF、D-RSBI差异均无统计学意义(均 P>0.05)。3次血液灌流后,治疗组IL-6、D-RSBI分别为(37.9±6.2)ng/L、(0.77±0.20)次·min^(-1)·mm^(-1),均低于对照组的(45.9±5.3)ng/L、(0.90±0.16)次·min^(-1)·mm^(-1)( t=-6.295、-3.382, P<0.001、 P=0.001),CHE、QI、DE、DTF分别为(2.29±0.52)kU/L、(264.5±24.3)mmHg、(16.5±1.9)mm、(27.2±4.7)%,均高于对照组的(1.96±0.39)kU/L、(252.6±27.2)mmHg、(14.3±1.6)mm、(23.5±4.1)%,差异均有统计学意义( t=3.258、2.141、5.598、3.877,均 P<0.05)。治疗组中间综合征发生率[4.7%(2/43)]、气管插管率[2.3%(1/43)]和住院时间[(11.8±1.8)d]均低于、短于对照组的23.8%(10/42)、19.0%(8/42)、(12.9±1.8)d(χ^(2)=6.432, P=0.011;χ^(2)=6.276, P=0.012;t=-2.932, P=0.004),两组28 d病死率差异无统计学意义( P>0.05)。 结论:血液灌流可改善重度有机磷农药中毒患者膈
Objective To investigate the clinical efficacy of hemoperfusion in the treatment of severe organophosphorus poisoning and its effect on diaphragm function.Methods Eighty-five patients with severe organophosphorus poisoning who received treatment in Affiliated Huxi Hospital of Jining Medical University(Shanxian Central Hospital),China between January 2018 and January 2020 were included in this study.They were randomly divided into treatment(n=43)and control(n=42)groups.The control group was given conventional treatment including gastric lavage,catharsis,and application of reactivators and anticholinergic drugs.The treatment group was subjected to three times of hemoperfusion,with an interval of 24 hours between two hemoperfusion interventions based on the conventional treatment used in the control group.Before and after three times of hemoperfusion,serum levels of cholinesterase(CHE),interleukin-6(IL-6),arterial partial pressure of oxygen(PaO_(2)),and arterial partial pressure of carbon dioxide(PaCO_(2))were measured.The Acute Physiology and Chronic Health Evaluation(APACHE)II score and oxygenation index(OI)in each group were calculated.Right diaphragmatic activity,diaphragmatic thickness at the end of inspiration(DTei)and diaphragmatic thickness at the end of expiration were measured by bedside ultrasound.The diaphragmatic thickening rate(DTF)and diaphragmatic rapid shallow breathing index(D-RSBI)were calculated.Serum CHE and IL-6 levels,OI,diaphragmatic activity,DTF and D-RSBI were compared between the treatment and control groups.The incidence of intermediate syndrome,tracheal intubation rate,28-day mortality rate,and hospital stay were compared between the two groups.Results Before hemoperfusion,there were no significant differences in serum levels of CHE and IL-6,OI,right diaphragmatic activity,DTF,and D-RSBI between the treatment and control groups(all P>0.05).After three times of hemoperfusion,serum IL-6 level and D-RSBI in the treatment group were(37.9±6.2)ng/L and(0.77±0.20)times/min/mm,which were signi
作者
刘景刚
张哲
冯慧
包东
杨文宝
张珂
Liu Jinggang;Zhang Zhe;Feng Hui;Bao Dong;Yang Wenbao;Zhang Ke(Department of Intensive Care Unit,Affiliated Huxi Hospital of Jining Medical University(Shanxian Central Hospital),Shanxian 274300,Shandong Province,China)
出处
《中国基层医药》
CAS
2021年第8期1131-1135,共5页
Chinese Journal of Primary Medicine and Pharmacy
基金
济宁医学院教师科研扶持基金项目(JYFC2018FKW62)。
关键词
有机磷中毒
血液灌流
膈
胆碱酯酶类
超声检查
白细胞介素6
Organophosphate poisoning
Hemoperfusion
Diaphragm
Cholinesterases
Ultrasonography
Interleukin-6
