血液灌流治疗急性有机磷中毒中间期肌无力综合征的疗效评价

摘要

目的 探讨血液灌流治疗急性有机磷中毒(acute organophosphate poisoning,AOPP)致中间期肌无力综合征(intermediate symdrome,IMS)的临床疗效.方法 选取2006至2011年收住我院急诊科的AOPP并发IMS综合征且临床资料完整的患者80例,其中血液灌流治疗组36例,非血液灌流治疗组44例.分析两组患者的临床特点和治疗效果.结果 与入院首次比较,入院后24、72 h血液灌流组和入院后72 h非血液灌流组患者血液胆碱酯酶活力上升,差异均有统计学意义(P＜0.05).入院后24 h时,血液灌流组患者血液胆碱酯酶活力明显高于非血液灌流组,差异有统计学意义(P＜0.05).血液灌流组患者使用阿托品总剂量、呼吸机使用天数、入住ICU时间、昏迷至清醒时间均明显低于非血液灌流组,差异均有统计学意义(P＜0.05).血液灌流组患者肺部感染的发生率和因呼吸衰竭死亡的比例较非血液灌流组明显降低,差异均有统计学意义(P＜0.05).两组患者的上消化道出血的发生率和病死率比较,差异无统计学意义(P＞0.05).结论 血液灌流可以缩短IMS患者的病程,减少并发症,降低因呼吸衰竭而死亡的比例.%Objective To evaluate the therapeutic efficacy of hemoperfusion in the treatment of intermediate myasthenia syndrome (IMS) following acute organophosphate poisoning (AOPP).Methods Eighty cases of IMS following AOPP,who were admitted to the Emergency Department of our hospital from 2006 to 2011 and had complete clinical records,were divided into HP treatment group (n=36) and non-HP (NHP)treatment group (n=44).The therapeutic efficacy of HP was evaluated by comparing the clinical data of the two groups.Results The HP treatment group showed significantly increased serum cholinesterase activity at 24 h and 72 h after admission (P＜0.05),while the NHP treatment group showed significantly increased serum cholinesterase activity at 72 h after admission (P＜0.05).The serum cholinesterase activity in the HP treatment group was significantly higher than that in the NHP treatment group at 24 h after admission (P＜0.05).Compared with the NHP treatment group,the HP treatment group had significantly decreased total atropine dose,time of ventilatory assistance,length of ICU stay,recovery time from coma,incidence of pulmonary infection,and mortality due to respiratory failure (P＜0.05).There were no significant differences in the incidence of upper gastrointestinal hemorrhage and total mortality between the two groups (P＞0.05).Conclusion Hemoperfusion is an effective therapy for improving clinical symptoms,shorten the course of disease,reducing complications,and decreasing the mortality due to respiratory failure in the patients with IMS following AOPP.