乌司他丁联合血液灌流治疗重度有机磷中毒临床疗效观察

目的观察乌司他丁联合血液灌流治疗重度有机磷中毒的临床治疗效果。方法将30例重度有机磷中毒患者随机分为实验组（乌司他丁＋血液灌流,n=15）和对照组（常规治疗＋血液灌流,n=15）。对照组按常规给予洗胃、导泻、阿托品、呼吸支持及血液灌流等综合治疗,实验组在上述基础上给予乌司他丁20万U静脉注射,2次/d。观察两组患者的阿托品治疗总量、胆碱酯酶活力恢复时间;两组患者治疗前及治疗后1h、2h、24h、48h血清肿瘤坏死因子α（TNF-α）,白细胞介素6（IL-6）,超敏C反应蛋白（hs-CRP）水平。结果两组患者治疗后血清TNF-α、IL-6、hs-CRP水平均较治疗前有明显降低（P〈0.05）;治疗后各时点实验组血清TNF-α、IL-6、hs-cRP水平均低于对照组（P〈0.05）;两组患者阿托品治疗总量及胆碱酯酶活力恢复时间比较,实验组明显低于对照组（P〈0.05）。结论对于重度有机磷农药中毒患者,乌司他丁联合血液灌流能明显减轻患者的全身炎症反应,显著提高临床治疗效果。

Ulinastatin combined with hemoperfusion in the treatment of severe organophosphorus pesticide poisoning

Objective To study clinical efficacy of ulinastatin combined with hemoperfusion in the treatment of severe organophosphorus pesticide poisoning.Methods 30 patients with severe organophosphorus pesticide poisoning were randomly divided into experimental group(UTI+hemoperfusion,n=15) and control group(conventional therapy+hemoperfusion,n=15).The control group were given comprehensive treatment of routine gastric lavage,catharsis,atropine,respiratory support,and hemoperfusion.The experimental group based on the above given ulinastatin 200 000 u intravenous,twice daily.Observed two groups of patients with total amount of atropine treatment,recovery time of cholinesterase activity,two groups of patients before and after treatment 1 h,2 h,24 h,48 h levels of TNF-α,IL-6,hs-CRP.Results Levels of TNF-α,IL-6,hs-CRP of patients in two groups were significantly decreased compared with them before treatment(P<0.05);after treatment each time point in the experimental group TNF-α,IL-6,hs-cRP were lower than those in the control group(P<0.05);the experimental group total amount of atropine treatment and cholinesterase activity recovery time were significantly lower than those in the control group(P<0.05).Conclusion Ulinastatin combined with hemoperfusion can reduce the systemic inflammatory response syndrome,which significantly increase efficacy in the treatment of severe organophosphorus pesticide poisoning.