血液灌流联合血液滤过对急性有机磷农药中毒并发急性胰腺炎的疗效

目的探讨血液灌流联合连续性静脉－静脉血液滤过(CVVH)在治疗急性有机磷农药中毒(AOPP)并发急性胰腺炎中的作用。 方法回顾性分析山东省聊城市人民医院急诊科2016年1月至2018年1月收治的45例AOPP并发急性胰腺炎患者资料，其中男性19例，女性26例；年龄19～70岁，平均(45.3±10.6)岁。按治疗方式不同分为血液净化组(n＝23)和常规治疗组(n＝22)。常规治疗组规范化应用肟类复能剂和抗胆碱能药物、生长素抑制剂、洗胃、导泻、抑制胃酸及胰酶分泌、维持水电解质平衡、营养支持等对症支持治疗，血液净化组在常规治疗手段的基础上采用血液灌流联合CVVH治疗。观察两组患者在入院时及入院各时间点(24、48和72 h)静脉血血常规[白细胞计数(WBC)、中性粒细胞数(NEUT)]及降钙素原(PCT)水平变化；比较两组患者乙酰胆碱酯酶(AchE)和淀粉酶(AMY)恢复正常范围的时间、阿托品人均用量以及重症监护病房(ICU)住院天数。 结果两组患者入院时静脉血WBC、NEUT及PCT比较差异均无统计学意义(P均>0.05)。血液净化组患者白细胞计数(WBC)在治疗24、48、72 h均低于常规治疗组[(13.45±2.37)×10⁹∶(15.72±1.83)×10⁹，(11.57±1.53)×10⁹∶(14.1±1.7)×10⁹，(9.06±1.42)×10⁹∶(11.82±1.86)×10⁹，P均<0.05)]，治疗48 h和72 h时NEUT也低于常规治疗组[(6.56±0.82)×10⁹∶(8.78±0.96)×10⁹；(5.37±0.34)×10⁹∶(8.64±0.93)×10⁹，P均<0.05]，此外，血液净化组患者PCT水平在治疗48 h和72 h的检测结果也低于常规治疗组[(0.56±0.12)×10⁹∶(0.88±0.28)×10⁹，(0.37±0.06)×10⁹∶(0.59±0.11)×10⁹，P均<0.05)]。血液净化组患者AchE恢复正常时间[(6.55 ± 1.15)d vs (11.35 ± 2.05)d]、AMY恢复正常时间[(3.75 ± 1.34)d∶(5.07±1.38)d]、人均阿托品用量[(225.18±57.24)mg∶(457.35±87.56)mg]及ICU住院时间[(4.15 ± 0.55)d∶(5.43 ± 0.35)d]均显著低于常规治疗组(P均<0.05)。 结论血液灌流联合CVVH能减轻患者的炎症反应、减少阿托品用量、缩短住院时间，在急性AOPP并发急性胰腺炎治疗中临床疗效显著。

Clinical effect of hemoperfusion combined with hemofiltration in acute pancreatitis associated with acute organophosphorus pesticide poisoning

ObjectiveTo investigate the role of hemoperfusion combined with continuous veno-venous hemofiltration (CVVH) in the treatment of acute organophosphorus pesticide poisoning (AOPP) complicated with acute pancreatitis. MethodsForty-five AOPP-induced AP patients were randomly divided into blood purification group (n=23) and conventional group (n=22). The changes of white blood cell count (WBC), neutrophil count (NEUT) and procalcitonin (PCT) before treatment and 24, 48, 72 h after admission were observed in two groups of patients. Choline Esterase (AchE), serum amylase (AMY) return to normal time, per capita atropine consumption and the days of patients living in the ICU were compared. ResultsThere were no significant differences in WBC, NEUT and PCT between the two groups before treatment (P>0.05). The white blood cell count (WBC) of patients in the blood purification group was lower than that of the conventional group at the time of 24 h, 48 h and 72 h [(13.45±2.37)×10^9 vs (15.72±1.83)×10^9, (11.5±1.5)×10^9 vs(14.12±1.74)×10^9, (9.06±1.42)×10^9 vs (11.82±1.86)×10^9, all P<0.05); The number of neutrophils (NEUT) in the blood purification group was significantly lower at 48h and 72h than those in the conventional group [(6.56±0.82)×10^9 vs (8.78±0.96)×10^9 and (5.37±0.34) ×10^9 vs (8.64±0.93)×10^9, all P<0.05); In the blood purification group, the procalcitonin (PCT) was lower at 48h and 72 h than that in the conventional group [(0.56±0.12)×10^9 vs (0.88±0.28)×10^9 and (0.37±0.06)×10^9 vs (0.59± 0.11)×10^9, all P <0.05 ]; The serum cholinesterase recovery time, amylase recovery time, per capita atropine consumption and patients' ICU time in the blood purification group were significantly less than those in the conventional group [(6.55 ± 1.15) d vs (11.35±2.05) d; 3.75±1.34 d vs 5.07±1.38 d and 225.18±57.24 mg vs 457.35±87.56 mg and 4.15±0.55 d vs 5.43±0.35 d, all P<0.05]. ConclusionHemoperfusion combined with continuous veno-venous hemofiltration can reduce the inflammatory response and the amount of atropine, shorten the hospital stay. It is worth in the treatment of the acute organophosphorus pesticide poisoning complicated by acute pancreatitis.