血液灌流联合血液滤过对急性有机磷农药中毒患者的心脏保护作用研究

目的探讨血液灌流(HP)联合连续性静脉-静脉血液滤过(CVVH)对急性有机磷农药中毒(AOPP)患者的心脏保护作用和心功能影响。方法以81例重症AOPP并中毒性心肌炎患者为研究对象,随机分为对照组40例,给予常规内科治疗+HP;治疗组41例,给予常规内科治疗和HP+CVVH。观察两组患者治疗开始前及治疗24 h、48 h、72 h,各时间点左心室射血分数(LVEF)、B型脑钠肽(BNP)、肌钙蛋白I(cTnI)及机械通气天数和病死率的差异。结果 (1)两组患者治疗前LVEF(47.6±9.9)%vs.(47.4±10.1)%,P>0.05]、BNP(516.3±285.4)pg/L vs.(534.4±301.9)pg/L,P>0.05]及cTnI(0.61±0.26)ng/ml vs.(0.58±0.23)ng/ml,P>0.05]比较均无统计学差异,组间有可比性。(2)治疗组较对照组,治疗后各时间点LVEF均增大(52.8±7.5)%vs.(47.6±8.4)%,(55.2±5.2)%vs.(50.9±7.2)%,(60.1±6.4)%vs.(53.6±5.4)%,均P<0.05],BNP均减小(321.7±182.8)pg/L vs.(495.9±269.9)pg/L,(254.7±117.8)pg/L vs.(382.7±167.5)pg/L,(125.4±62.7)vs.(293.8±121.1)pg/L,均P<0.05],cTnI均减小(2.16±0.48)ng/ml vs.(2.79±0.36)ng/ml,(5.37±3.79)ng/ml vs.(8.35±4.51)ng/ml,(3.01±1.26)ng/ml vs.(8.41±5.45)ng/ml,P<0.05],差异有统计学意义。(3)治疗组治疗后各时间点与治疗前比较,LVEF均增大(52.8±7.5)%、(55.2±5.2)%、(60.1±6.4)%vs.(47.6±9.9)%,均P<0.01],BNP均减小(321.7±182.8)pg/L、(254.7±117.8)pg/L、(125.4±62.7)pg/L vs.(516.3±285.4)pg/L,均P<0.01],差异有统计学意义。(4)对照组治疗后24 h与治疗前比较,LVEF、BNP均无统计学差异;治疗后48 h、72 h与治疗前比较,LVEF均增大(50.9±7.2)%、(53.6±5.4)%vs.(47.4±10.1)%,均P<0.05],BNP均减小(382.7±167.5)pg/L、(293.8±121.1)pg/L vs.(534.4±301.9)pg/L,均P<0.01],差异有统计学意义。(5)治疗组较对照组机械通气时间缩短(7.4±2.9)d vs.(10.7±4.1)d,P=0.001],病死率下降(12.2%vs.30.0%,P=0.048)。结论 HP联合CVVH能够减轻AOPP的心肌损伤,改善心功能,缩短机械通气时间,降低病死率,改善患者预后。

Study of hemoperfusion combined with continuous veno-venous hemofdtration on heart protection in patients with acute organophosphorus pesticide poisoning

Objective To investigate the heart protection and the effects of cardiac function for acute organophosphorus pesticide poisoning （AOPP） by sequential blood purification （hemoperfusion HP combined with continuous veno-venous hemofiltration CVVH）. Methods 81 patients with severe AOPP and toxic myocarditis were researched and randomly divided into two groups.In control group, 40 patients were treated with conventional therapy with HP. In the treated group, the 41 patients were treated with HP＋CVVH on the basis of the conventional therapy. The days of mechanical ventilation, case fatality rate and the difference of two groups on left ventricular ejection fraction （LVEF）, B-type natriuretic peptide （BNP）, troponin I（cTnI） were compared with before treatment and at the 24 h/48 h/72 h after treatment. Results （1）In treatment group and control group, the LVEF（47.6±9.9）% vs. （47.4±10.1）%, P〉0.05], BNP（516.3±285.4）pg/L vs. （534.4±301.9）pg/L, P〉0.05] and cTnI（0.61±0.26）ng/ml vs. （0.58±0.23） ng/ml, P〉0.05] compared before treatment had no significant difference, there was comparable between two groups. （2）The LVEF at each time point after treatment in the treatment group was significantly increased more than that of the control group（52.8±7.5）%vs. （47.6±8.4）%, （55.2±5.2）%vs. （50.9±7.2）%, （60.1±6.4）% vs. （53.6±5.4）%, all P〈0.05], the BNP was decreased significantly （321.7±182.8）pg/L vs. （495.9±269.9）pg/L, （254.7±117.8）pg/L vs. （382.7±167.5）pg/L, （125.4±62.7） vs. （293.8±121.1）pg/L, all P〈0.05], and the cTnI was decreased significantly（2.16±0.48）ng/ml vs. （2.79±0.36）ng/ml, （5.37±3.79）ng/ml vs. （8.35±4.51）ng/ml, （3.01±1.26）ng/ml vs. （8.41±5.45）ng/ml, P〈0.05], There were significant difference between the two groups（ all P〈0.01 or 0.05）. （3） The LVEF was increased（52.8±7.5）%, （55.2±5.2）%, （60.1±6.4）%vs. （47.6±9.9）%, all P〈0.01] and