脂肪乳注射液联合血液灌流对急性有机磷农药中毒患者疗效的影响

Efficacy of fat emulsion injection combined with hemoperfusion in patients with acute organophosphorus pesticide poisoning

摘要:

目的 探讨脂肪乳注射液联合血液灌流对急性有机磷农药中毒（AOPP）患者疗效的影响。方法 选取2017年1月—2022年1月连云港市第二人民医院收治的72例AOPP患者。将患者分为对照组（血液灌流治疗）和研究组（脂肪乳注射液联合血液灌流治疗），每组36例。比较两组患者苏醒时间、胆碱酯酶（CHE）恢复正常时间及住院时间。比较两组患者临床疗效、神经功能指标［运动神经传导速度（MCV）、感觉神经传导速度（SCV）］、心功能指标［左室射血分数（LVEF）、左室收缩末期内径（LVIDs）］、心肌酶谱水平及胃肠功能［瓜氨酸（Cit）、二胺氧化酶水平（DAO）］。比较两组患者并发症发生情况。结果 研究组苏醒时间、CHE恢复正常、住院时间短于对照组（P <0.05）；研究组总有效率高于对照组（P <0.05）；研究组治疗后MCV、SCV均高于对照组（P <0.05）；研究组治疗后LVEF高于对照组（P <0.05），LVIDs低于对照组（P <0.05）；研究组治疗后LDH、CK及CK-MB水平均低于对照组（P <0.05）；研究组治疗后Cit高于对照组（P <0.05），DAO低于对照组（P <0.05）；研究组与对照组并发症总发生率，差异无统计学意义（P >0.05）。结论 脂肪乳注射液联合血液灌流治疗AOPP患者可促进患者恢复，提高临床疗效，并改善神经功能和心功能，减轻心肌损伤，恢复肠胃功能，安全可靠。

Abstract:

Objective To investigate the efficacy of fat emulsion injection combined with hemoperfusion in patients with acute organophosphorus pesticide poisoning (AOPP) and to determine its myocardial protective effects.Methods A total of 72 patients with AOPP who were treated in Lianyungang Second People's Hospital from January 2017 to January 2022 were selected, and were divided into the control group (hemoperfusion therapy, 36 cases) and the study group (fat emulsion injection combined with the hemoperfusion therapy, 36 cases). The time to awakening, time to cholinesterase (CHE) recovery and the length of hospital stay were compared between the two groups. The therapeutic outcome, neurological function indexes [motor nerve conduction velocity (MCV) and sensory nerve conduction velocity (SCV) ], cardiac function indexes [left ventricular ejection fraction (LVEF) and left ventricular end-systolic internal dimension (LVIDs) ], levels of myocardial enzymes [lactate dehydrogenase (LDH), creatine kinase (CK), and creatine kinase isoenzyme (CK-MB) ], and the gastrointestinal function [levels of citrulline (Cit) and diamine oxidase ( DAO) ] were also compared. In addition, the incidence of complications in the two groups was compared.Results The time to awakening, time to CHE recovery and the length of hospital stay in the study group were shorter than those in the control group (P < 0.05). The overall effective rate in the study group was higher than that in the control group (P < 0.05). After the treatment, the MCV and SCV of the study group were higher than those of the control group (P < 0.05). The LVEF in the study group was higher than that in the control group (P < 0.05), while the LVIDs in the study group was lower than that in the control group after the treatment (P < 0.05). Compared with the control group, the levels of LDH, CK and CK-MB after the treatment were lower in the study group (P < 0.05). After treatment, the level of Cit in the study group was higher than that in the control group (P < 0.05), and the level of DAO in the study group was lower than that in the control group (P < 0.05). There was no significant difference in the overall incidence of complications between the study group and the control group (P > 0.05).Conclusions In the treatment of AOPP, fat emulsion injection combined with hemoperfusion is beneficial to promote the recovery of patients, to enhance the clinical efficacy, to improve the neurological, cardiac and gastrointestinal function, and to mitigate the myocardial injury without safety concerns.