CAJ | 학술논문

目的探讨脂肪乳对急性有机磷中毒的疗效及对急性有机磷中毒所致急性肺损伤的治疗作用.方法取封闭SD大鼠48只,随机(随机数字法)分为A、B、C、D四组,予敌敌畏11 mg/kg腹腔注射染毒,注射过程中无药物损失即为染毒成功.A组为盐水对照组,染毒后予生理盐水(5 ml/kg)静脉注射；B组为脂肪乳对照组,染毒后予20％脂肪乳(5 ml/kg)静脉注射；C组为常规治疗组,染毒后立即予阿托品( 10 mg/kg)和氯解磷定(40 mg/kg)肌肉注射；D组为脂肪乳治疗组,在C组的基础上联合应用20％脂肪乳(5ml/kg)静脉注射.分别于染毒前,染毒后30 min、2h、4h,采眶下血1 ml行全血胆碱酯酶检查；染毒后24 h内观察大鼠肌颤,流涎等中毒表现和存活情况；染毒后24 h后取肺组织称量湿质量并行电镜检查.两样本均数间比较采用成组t检验,两样本率的比较采用x2检验.结果敌敌畏染毒后,A、B两组大鼠肌颤、流涎症状出现较早且较重；C,D两组较A、B两组,D组较C组24 h存活率高,肌颤强度较弱,差异有统计学意义(P＜0.05).B组24 h存活率由A组的1/12提高到2/12,两组之间差异无统计学意义(P＞0.05).染毒后较染毒前胆碱酯酶下降明显,差异具有统计学意义(P＜0.05)；染毒后30min,C、D两组胆碱酯酶活力明显高于A组,差异具有统计学意义(P＜0.05)；B组较A组,C、D两组较B组胆碱酯酶活力升高,但差异无统计学意义(P＞0.05)；染毒后2h及4h,C、D两组较A、B两组,D组较C组,B组较A组胆碱酯酶活力明显升高,差异具有统计学意义(P＜0.05).染毒后24 h,C、D两组较A、B两组,D组较C组,B组较A组,肺湿质量差异具有统计学意义(P＜0.05).肺组织电镜检查示脂肪乳辅助治疗组较其他3组肺组织改变明显减轻.结论脂肪乳与阿托品和氯磷定联合应用,可以减轻敌敌畏中毒症状,降低病死率,加快胆碱酯酶恢复,减轻急性有机磷中毒导致的肺损伤. 目的探討脂肪乳對急性有機燐中毒的療效及對急性有機燐中毒所緻急性肺損傷的治療作用.方法取封閉SD大鼠48隻,隨機(隨機數字法)分為A、B、C、D四組,予敵敵畏11 mg/kg腹腔註射染毒,註射過程中無藥物損失即為染毒成功.A組為鹽水對照組,染毒後予生理鹽水(5 ml/kg)靜脈註射；B組為脂肪乳對照組,染毒後予20％脂肪乳(5 ml/kg)靜脈註射；C組為常規治療組,染毒後立即予阿託品( 10 mg/kg)和氯解燐定(40 mg/kg)肌肉註射；D組為脂肪乳治療組,在C組的基礎上聯閤應用20％脂肪乳(5ml/kg)靜脈註射.分彆于染毒前,染毒後30 min、2h、4h,採眶下血1 ml行全血膽堿酯酶檢查；染毒後24 h內觀察大鼠肌顫,流涎等中毒錶現和存活情況；染毒後24 h後取肺組織稱量濕質量併行電鏡檢查.兩樣本均數間比較採用成組t檢驗,兩樣本率的比較採用x2檢驗.結果敵敵畏染毒後,A、B兩組大鼠肌顫、流涎癥狀齣現較早且較重；C,D兩組較A、B兩組,D組較C組24 h存活率高,肌顫彊度較弱,差異有統計學意義(P＜0.05).B組24 h存活率由A組的1/12提高到2/12,兩組之間差異無統計學意義(P＞0.05).染毒後較染毒前膽堿酯酶下降明顯,差異具有統計學意義(P＜0.05)；染毒後30min,C、D兩組膽堿酯酶活力明顯高于A組,差異具有統計學意義(P＜0.05)；B組較A組,C、D兩組較B組膽堿酯酶活力升高,但差異無統計學意義(P＞0.05)；染毒後2h及4h,C、D兩組較A、B兩組,D組較C組,B組較A組膽堿酯酶活力明顯升高,差異具有統計學意義(P＜0.05).染毒後24 h,C、D兩組較A、B兩組,D組較C組,B組較A組,肺濕質量差異具有統計學意義(P＜0.05).肺組織電鏡檢查示脂肪乳輔助治療組較其他3組肺組織改變明顯減輕.結論脂肪乳與阿託品和氯燐定聯閤應用,可以減輕敵敵畏中毒癥狀,降低病死率,加快膽堿酯酶恢複,減輕急性有機燐中毒導緻的肺損傷.
목적 탐토지방유대급성유궤린중독적료효급대급성유궤린중독소치급성폐손상적치료작용.방법 취봉폐SD대서48지,수궤(수궤수자법)분위A、B、C、D사조,여활활외11 mg/kg복강주사염독,주사과정중무약물손실즉위염독성공.A조위염수대조조,염독후여생리염수(5 ml/kg)정맥주사；B조위지방유대조조,염독후여20％지방유(5 ml/kg)정맥주사；C조위상규치료조,염독후립즉여아탁품( 10 mg/kg)화록해린정(40 mg/kg)기육주사；D조위지방유치료조,재C조적기출상연합응용20％지방유(5ml/kg)정맥주사.분별우염독전,염독후30 min、2h、4h,채광하혈1 ml행전혈담감지매검사；염독후24 h내관찰대서기전,류연등중독표현화존활정황；염독후24 h후취폐조직칭량습질량병행전경검사.량양본균수간비교채용성조t검험,량양본솔적비교채용x2검험.결과 활활외염독후,A、B량조대서기전、류연증상출현교조차교중；C,D량조교A、B량조,D조교C조24 h존활솔고,기전강도교약,차이유통계학의의(P＜0.05).B조24 h존활솔유A조적1/12제고도2/12,량조지간차이무통계학의의(P＞0.05).염독후교염독전담감지매하강명현,차이구유통계학의의(P＜0.05)；염독후30min,C、D량조담감지매활력명현고우A조,차이구유통계학의의(P＜0.05)；B조교A조,C、D량조교B조담감지매활력승고,단차이무통계학의의(P＞0.05)；염독후2h급4h,C、D량조교A、B량조,D조교C조,B조교A조담감지매활력명현승고,차이구유통계학의의(P＜0.05).염독후24 h,C、D량조교A、B량조,D조교C조,B조교A조,폐습질량차이구유통계학의의(P＜0.05).폐조직전경검사시지방유보조치료조교기타3조폐조직개변명현감경.결론 지방유여아탁품화록린정연합응용,가이감경활활외중독증상,강저병사솔,가쾌담감지매회복,감경급성유궤린중독도치적폐손상.
Objective To explore the therapeutic effect of lipid emulsion on acute organophosphorus poisoning and its consequence of acute lung injury. Methods A total of 48 sealant - grade Sprague-Dawley (SD) rats were randomly divided into four groups A,B,C,D,namely saline control group,lipid emulsion control group,the conventional therapy group and lipid emulsion administration group. After dichlorvos (DDVP) 11 mg/kg was given by intra-peritoneal injection,if there was no loss of DDVP during the injection process,the model of poisoning was considered to be made successfully.Then the rat models in four groups were respectively treated:with normal saline (5 ml/kg) intravenous injection in group A,lipid emulsion (5ml/kg) intravenous injection in group B,atropine (5 mg/kg) and pralidoxime chloride (40 mg/kg) intramuscular injection in group C,and combined use of lipid emulsion (5 ml/kg) with atropine and pralidoxime chloride in group D after administration of DDVP by intra-peritoneal injection.The activity of cholinesterase (CHE) in blood was detected before and 0.5 h,2 h and 4 h after DDVP poisoning. The clinical manifestations,the survival of rats,the wet weight of rat' s lung and the pathological changes of the lung tissue were observed within following 24 h. The rates of survival and symptoms of rats were compared between paired groups by using the x2 test,and the mean values of biomarkers were compared paired groups by using t test. Results In groups A and B,the intensity of muscular fasciculation and salivation were more severe and appeared sooner after DDVP exposure in comparison with groups C and D leading to lower survival rates in group A and B. Compared with group C,the rate of 24 h survival was higher and the intensity of muscular fasciculation was weaker in group D ( P ＜ 0.05 ).In group A and group B,the 24-hour survival rates were 1/12 and 2/12,respectively ( P ＜ 0.05 ).The levels of CHE in blood significantly decreased after DDVP poisoning ( P ＜ 0.05 ).There was no significant difference in activity of CHE between group B and group A,and in groups C and D,the levels of CHE in blood were not significantly higher than that in the group B 0.5 h after DDVP poisoning ( P ＜ O.05 ).In groups C and D,the activity of CHE in blood was significantly higher compared with group A and B,and that in group D was higher compared with C,and that in group B was higher compared with A 2 and 4 hours after DDVP poisoning ( P ＜ 0.05 ).In groups C and D,the wet weight of rat lung was significantly lighter compared with groups A and B,and that in group D was lighter compared with C,and that in group B was lighter compared with A 24 h after DDVP poisoning P ＜ 0.05 ).The electron microscopic findings showed the combined use of lipid emulsion with atropine and pralidoxime chloride obviously lessened the lung histopathologic changes after DDVP poisoning.Conclusions The lipid emulsion combined with atropine and pralidoxime chloride can be beneficial to controlling the toxic symptoms,reduce the death rate,accelerate the resume of the activity of CHE in blood,and relieve the lung injury induced by acute organophosphorus poisoning.