单次或多次血液灌流对重度有机磷农药中毒的疗效比较

目的 比较血液灌流(HP)次数对重度急性有机磷农药中毒患者的临床疗效。 方法 回顾性分析2014年1月—2018年7月安徽理工大学附属亳州市人民医院收治的86例急性重度有机磷农药中毒患者，根据HP治疗次数分为对照组(HP 0次，26例)，HP单次组(HP 1次，31例)，HP多次组(HP≥2次，29例)。比较3组患者长托宁和解磷定总用量，血清胆碱酯酶活性恢复80%时间(h1)、昏迷时间(h2)、住院时间(h3)、机械通气时间(h4)及中间综合征、中毒反跳、心律失常、多器官功能障碍综合征发生率、病死率。 结果 对照组、HP单次组、HP多次组长托宁总量[(38.28±11.33)mg、(25.62±9.57)mg、(16.54±9.45)mg]和解磷定总量[(22.35±5.45)mg、(16.53±3.64)mg、(10.22±2.45)mg]依次减少(均P＜0.05)，h1[(15.32±3.42)h，(10.26±2.04)h，(7.32±3.64)h],h2[(96.23±8.22)h，(46.28±7.69)h，(28.56±7.21)h],h3[(18.21±3.22)d，(13.52±3.64)d，(8.23±2.33)d]、h4[(136.42±18.68)h，(92.46±16.28)h，(47.28±15.42)h]依次缩短(均P＜0.05)，入院72 h APACHE-Ⅱ评分(18.23±4.12，15.25±3.06，12.52±2.08)依次降低(P＜0.05)。HP多次组中间综合征、反跳、MODS发生例数少于对照组和HP单次组，差异具统计学意义(均P＜0.05)。HP多次组和HP单次组心律失常例数均少于对照组(均P＜0.05)。病死数构成3组间差异无统计学意义(P>0.05)。 结论 重度有机磷中毒患者多次行血液灌流临床治疗效果可，并发症少。 

Comparison of therapeutic effects of single and multiple hemoperfusion on severe acute organophosphorus poisoning

Objective To compare the clinical efficacy of hemoperfusion (HP) times in patients with severe acute organophosphorus poisoning. Methods Eighty-six patients with severe acute organophosphorus poisoning (AOPP) admitted to intensive care unit from January 2014 to July 2018 were divided into 3 groups basing on times of hemoperfusion (HP), including a HP0 group of 26 cases received no hemoperfusion treatment, a HP1 group of 31 cases received once hemoperfusion treatment, and a HP2 of 29 cases received twice or more hemoperfusion treatments. Then the total dose of atropine and pralidoxime, recovery of 80% serum cholinesterase activity, duration of coma, hospital stay, time of mechanical ventilation, acute physiology and chronic health status scoring system Ⅱ (APACHE Ⅱ) score at 72 h after admission, and incidence of complications (intermediate syndrome, poisoning rebound, arrhythmia, organ dysfunction syndrome) and mortality of the 3 groups were compared. Results Hemoperfusion treatment was correlated with total dose of atropine and pralidoxime, recovery of 80% serum cholinesterase activity, duration of coma, hospital stay, time of mechanical ventilation, acute physiology and chronic health status scoring system Ⅱ (APACHE Ⅱ) score at 72 h after admission, the incidence of complications (intermediate syndrome, poisoning rebound, organ dysfunction syndrome) in HP2 was less than the others and mortality (P<0.05 for all), the incidence of arrhythmia in HP1 and HP2 was less than the HP0. Conclusion Multiple times of hemoperfusion is a supplement to conventional treatment showed significant efficacy for AOPP patients.