中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2014年
18期
3283-3287
,共5页
杨圣强%刘贞%王波%杨文宝%刘景刚%袁继印%时启标
楊聖彊%劉貞%王波%楊文寶%劉景剛%袁繼印%時啟標
양골강%류정%왕파%양문보%류경강%원계인%시계표
有机磷化合物%利钠肽,脑%肌钙蛋白I%血液净化%左心室射血分数
有機燐化閤物%利鈉肽,腦%肌鈣蛋白I%血液淨化%左心室射血分數
유궤린화합물%리납태,뇌%기개단백I%혈액정화%좌심실사혈분수
Organic phosphorus compounds%Natriuretic peptide,brain%Troponin I%Blood purification%Left ventricular ejection fraction
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。
目的：探討血液灌流（HP）聯閤連續性靜脈-靜脈血液濾過（CVVH）對急性有機燐農藥中毒（AOPP）患者的心髒保護作用和心功能影響。方法以81例重癥AOPP併中毒性心肌炎患者為研究對象，隨機分為對照組40例，給予常規內科治療＋HP；治療組41例，給予常規內科治療和 HP＋CVVH。觀察兩組患者治療開始前及治療24 h、48 h、72 h，各時間點左心室射血分數（LVEF）、B型腦鈉肽（BNP）、肌鈣蛋白I（cTnI）及機械通氣天數和病死率的差異。結果（1）兩組患者治療前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]比較均無統計學差異，組間有可比性。（2）治療組較對照組，治療後各時間點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均減小[（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均減小[（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]，差異有統計學意義。（3）治療組治療後各時間點與治療前比較，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均減小[（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]，差異有統計學意義。（4）對照組治療後24 h與治療前比較，LVEF、BNP均無統計學差異；治療後48 h、72 h與治療前比較，LVEF均增大[（50.9±7.2）%、（53.6±5.4）%vs.（47.4±10.1）%，均P＜0.05]，BNP均減小[（382.7±167.5）pg/L、（293.8±121.1）pg/L vs.（534.4±301.9）pg/L，均P＜0.01]，差異有統計學意義。（5）治療組較對照組機械通氣時間縮短[（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）。結論 HP聯閤CVVH能夠減輕AOPP的心肌損傷，改善心功能，縮短機械通氣時間，降低病死率，改善患者預後。
목적：탐토혈액관류（HP）연합련속성정맥-정맥혈액려과（CVVH）대급성유궤린농약중독（AOPP）환자적심장보호작용화심공능영향。방법이81례중증AOPP병중독성심기염환자위연구대상，수궤분위대조조40례，급여상규내과치료＋HP；치료조41례，급여상규내과치료화 HP＋CVVH。관찰량조환자치료개시전급치료24 h、48 h、72 h，각시간점좌심실사혈분수（LVEF）、B형뇌납태（BNP）、기개단백I（cTnI）급궤계통기천수화병사솔적차이。결과（1）량조환자치료전LVEF[（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]급cTnI[（0.61±0.26）ng/ml vs.（0.58±0.23）ng/ml，P＞0.05]비교균무통계학차이，조간유가비성。（2）치료조교대조조，치료후각시간점LVEF균증대[（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）%，균P＜0.05]，BNP균감소[（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，균P＜0.05]，cTnI균감소[（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]，차이유통계학의의。（3）치료조치료후각시간점여치료전비교，LVEF균증대[（52.8±7.5）%、（55.2±5.2）%、（60.1±6.4）%vs.（47.6±9.9）%，균P＜0.01]，BNP균감소[（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，균P＜0.01]，차이유통계학의의。（4）대조조치료후24 h여치료전비교，LVEF、BNP균무통계학차이；치료후48 h、72 h여치료전비교，LVEF균증대[（50.9±7.2）%、（53.6±5.4）%vs.（47.4±10.1）%，균P＜0.05]，BNP균감소[（382.7±167.5）pg/L、（293.8±121.1）pg/L vs.（534.4±301.9）pg/L，균P＜0.01]，차이유통계학의의。（5）치료조교대조조궤계통기시간축단[（7.4±2.9）d vs.（10.7±4.1）d，P＝0.001]，병사솔하강（12.2%vs.30.0%，P＝0.048）。결론 HP연합CVVH능구감경AOPP적심기손상，개선심공능，축단궤계통기시간，강저병사솔，개선환자예후。
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 the BNP was decreased [(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, all P<0.01] at each time point after treatment compared with before treatment in the treatment group. The difference had statistical significance. (4) Compared with the LVEF [ (47.6±8.4)%vs. (47.4±10.1)%, P>0.05] and the BNP [ (495.9±269.90) pg/L vs. (534.4±301.9) pg/L, P>0.05], there were no significant differences between after treatment with 24h and before treatment in the control group. The LVEF was increased[(50.9±7.2)%, (53.6±5.4)% vs.(47.4±10.1)%, all P<0.05] and the BNP was decreased[(382.7±167.5)pg/L, (293.8±121.1)pg/L vs.(534.4±301.9)pg/L, all P<0.01] at 48 h, 72 h after treatment compared with before treatment in the treatment group. The difference has statistical significance. (5)Compared with control group, the days of mechanical ventilation in treatment group were shorted[(7.4±2.9)d vs.(10.7±4.1)d, P=0.001], and the case fatality rate were declined(12.2%vs. 30.0%, P=0.048). Conclusion Hemoperfusion combined with continuous veno-venous hemofiltration treatment of AOPP can reduce myocardial injury, improve the heart function, shortening the time of mechanical ventilation and reduce the case fatality rate, improve the prognosis of patients.
