早期乌司他丁联合血液灌流序贯连续性血液滤过治疗急性重度有机磷中毒临床效果观察

摘要

目的：观察早期乌司他丁联合血液灌流序贯连续性血液滤过治疗急性重度有机磷中毒的效果。方法选择2012年1月—2015年10月河北省邯郸市第一医院重症医学科诊治有机磷中毒患者42例，采用随机数字表法分为观察组和对照组各21例，观察组患者接受早期乌司他丁联合血液灌流序贯连续性血液滤过治疗，对照组接受血液灌流序贯连续性血液滤过治疗。比较2组临床指标、炎性因子及肝肾功能指标变化情况。结果观察组患者胆碱酯酶恢复时间、住 ICU 总时间均明显短于对照组（ t ＝2．623、2．021， P ＜0．01、 P ＜0．05）；治疗后1d、2d 时，观察组血清白细胞介素－10（IL－10）、C 反应蛋白（CRP）含量均明显低于对照组（ t ＝2．332、7．332、3．019、6．737， P ＜0．01或P ＜0．05），血清丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、血肌酐（SCr）含量亦均明显低于对照组（t ＝2．484、2．822、6．797、5．816、4．095、5．282， P ＜0．01或 P ＜0．05）。结论早期乌司他丁联合血液灌流序贯连续性血液滤过治疗急性重度有机磷中毒，有助于缓解炎性反应，保护肝肾功能，提高治疗效果。%Objective To observe the effect of ulinastatin combined with hemoperfusion in sequential continuous he-mofiltration in treatment of severe acute organophosphorus poisoning.Methods Ninety-two organic phosphorus poisoning pa-tients from September 2012 to October 2015 were randomly divided into observation group and control group, the observation group received anti-inflammatory combined with hemoperfusion sequential continuous hemofiltration treatment, the control group received sequential continuous hemoperfusion hemofiltration.Then clinical curative effect, inflammatory cytokines, liver and kidney function were compared between two groups.Results The observation group of patients with cholinesterase recov-ery time, ICU stay time were significantly shorter than the control group ( t =2.623, t =2.021, P <0.01, P <0.05); after treatment, the serum levels of interleukin 10 (IL-10), C reactive protein (CRP) content were significantly lower than the control group ( t =2.332, t =7.332, t =3.019, t =6.737, P <0.01 or P <0.05), serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum creatinine (SCr) levels were significantly lower than the control group (t =2.484, t =2.822, t =6.797, t =5.816, t =4.095, t =5.282, P <0.01 or P <0.05).Conclusion Early effects of ulinastatin combined with hemoperfusion sequential continuous hemofiltration in treatment of severe acute organophosphorus poisoning, helps relieve inflammatory reaction and protect liver and kidney function, improve the therapeutic effect.