CAJ | 학술논문

目的探讨血液灌流(hemoperfusion,HP)对兔甲胺磷中毒血中毒物的清除作用及对脏器的影响.方法健康日本大耳白兔16只,随机分为两组:灌流组和非灌流组,两组均予胃管灌注甲胺磷溶液20 mg/kg体质量,灌流组在常规治疗基础上,予中毒后60 min给予树脂血液灌流治疗;非灌流组仅给予洗胃、阿托品及胆碱酯酶复能剂等常规治疗.用气相色谱法测定染毒前、后不同时间点血中甲胺磷浓度;同时观察染毒后6 h两组血胆碱酯酶(ChE)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、乳酸脱氢酶(LDH)及心肌酶学(CK、CK-MB)的变化和肺、肝、肾、肌肉的病理学变化.实验所得结果均以均数±标准筹(x±s)表示,采用SPSS 10.0统计软件进行统计分析,灌流前后比较采用配对比较的t检验.两组间比较采用两样本均数比较的t检验.P<0.05为差异具有统计学意义.结果 ①兔经胃管灌入甲胺磷后,均出现了典型的有机磷农药中毒症状.灌流组灌流前血甲胺磷质量浓度为(11.43±1.56)μg/mL,灌流30,60,90,120 min血浆中甲胺磷质量浓度分别为(7.82±1.54),(4.97±1.58),(5.66±1.75),(5.49±1.68)μg/mL,与灌流前相比差异无统计学意义(P<0.01);并与同一时间点非灌流组相比差异具有统计学意义(P<0.01);灌流后中毒症状减轻;②两组兔中毒后血胆碱酯酶活性均出现明显下降,但差异无统计学意义(P>0.05);与灌流组相比,非灌流组血ALT,AST,LDH,CK和CK-MB明显升高(P<0.01),③兔染毒后6 h光镜下可见肌肉、肝、肾、肺组织出现不同程度损害,以非HP组明显.结论 ①血液灌流能有效清除血中甲胺磷含量,从而改善中毒后的临床症状;②早期积极HP治疗可减轻脏器损害,显示其对脏器的保护作用.
목적 탐토혈액관류(hemoperfusion,HP)대토갑알린중독혈중독물적청제작용급대장기적영향.방법 건강일본대이백토16지,수궤분위량조:관류조화비관류조,량조균여위관관주갑알린용액20 mg/kg체질량,관류조재상규치료기출상,여중독후60 min급여수지혈액관류치료;비관류조부급여세위、아탁품급담감지매복능제등상규치료.용기상색보법측정염독전、후불동시간점혈중갑알린농도;동시관찰염독후6 h량조혈담감지매(ChE)、곡병전안매(ALT)、곡초전안매(AST)、유산탈경매(LDH)급심기매학(CK、CK-MB)적변화화폐、간、신、기육적병이학변화.실험소득결과균이균수±표준주(x±s)표시,채용SPSS 10.0통계연건진행통계분석,관류전후비교채용배대비교적t검험.량조간비교채용량양본균수비교적t검험.P<0.05위차이구유통계학의의.결과 ①토경위관관입갑알린후,균출현료전형적유궤린농약중독증상.관류조관류전혈갑알린질량농도위(11.43±1.56)μg/mL,관류30,60,90,120 min혈장중갑알린질량농도분별위(7.82±1.54),(4.97±1.58),(5.66±1.75),(5.49±1.68)μg/mL,여관류전상비차이무통계학의의(P<0.01);병여동일시간점비관류조상비차이구유통계학의의(P<0.01);관류후중독증상감경;②량조토중독후혈담감지매활성균출현명현하강,단차이무통계학의의(P>0.05);여관류조상비,비관류조혈ALT,AST,LDH,CK화CK-MB명현승고(P<0.01),③토염독후6 h광경하가견기육、간、신、폐조직출현불동정도손해,이비HP조명현.결론 ①혈액관류능유효청제혈중갑알린함량,종이개선중독후적림상증상;②조기적겁HP치료가감경장기손해,현시기대장기적보호작용.
Objective To evaluate the clearance efficacy of resin hemoperfusion(HP) on the removal of organophosphorus in the rabbits poisoned by methamidophos(MAP) and its effects on organ injury. Method Six-teen healthy Japanese white rabbits were randomly divided into HP group and non-HP group. MAP was given through gastric tube in a dosage of 20 mg/kg to rabbits of both groups. Rabbits of liP group received resin hemop-ersion plus conventional treatment including early gastric lavage, atropine and pralidoxime. Rabbits of non-HP group received only conventional treatment. The plasma concentration of MAP was determined by using gas chro-matography before and after rabbits were poisoned at different intervals. Serum choline esterase (ChE),lactic de-hydrogenase (LDH), alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatine kinase (CK) and creatine kinase isoenzyme (CK-MB) of rabbits of both groups were assayed 6 hours after rabbits poisoned. Pathological changes in lung, liver, kidney and muscle were investigated simutaneously. SPSS 10.0 software was used for statistical analysis. The comparison between groups was carried out by using t -test. Results ① The typical symptoms of organophospborus poisoning were occurred in rabbits within 5 - 10 minutes after ingestion of MAP. In HP group, the plasma levels of rabbits before,and 30 min,60 min,90 min and 120 min after hemoperfu-sion were (11.43±1.56),(7.82±1.54),(4.97±1.58),(5.66±1.75) ,(5.49±1.68) μg/mL, respectively (P <0.01). After hemoperfusion, the plasma MAP levels of rabbits in HP group were lower than those in non-HP groups (P < 0.01). The improveme, nt of clinical presentation of rabbits was observed shortly after HP. ② The blood choline esterase activity of rabbits were depressed in hoth groups without significant difference. In contrast, the blood levels of ALT, AST,LDH,CK and CK-MB of rabbits in non-HP group elevated significantly than in HP group (P < 0.01). ③ The more severe injury of muscle, liver, kidnet and lung of rabbits can could be seen in non-HP group. Conclusions ① HP can effectively eliminate the plasma MAP and has the potential to improve the clinical presentation of intoxication in rabbits. ② Early intervention of Hp exerts a protection from organ dam-age of organophosphorus pesticide.