急性毒死蜱中毒患者的抢救及后期护理
급성독사비중독환자적창구급후기호리
Rescue and late nursing of patients with acute poisoning of chlorpyrifos
  • 万方数据
    中国医药导报 중국의약도보
    CHINA MEDICAL HERALD
    2015年 3期 155-158,168 ,共5页

    王麟麟%应瑶蓉%俞丽云

    왕린린%응요용%유려운

    毒死蜱%胆碱酯酶%血液灌流%后期护理 毒死蜱%膽堿酯酶%血液灌流%後期護理
    독사비%담감지매%혈액관류%후기호리
    Chlorpyrifos%Cholinesterase%Hemoperfusion%Late nursing
    目的：探讨急性毒死蜱中毒患者的抢救及后期护理措施。方法选取2011年7月~2014年7月在浙江省宁波市医疗中心李惠利医院救治的42例急性毒死蜱中毒患者作为研究对象，将全部入选病例随机分为观察组(21例)和对照组(21例)，对照组采用常规治疗方法，观察组在对照组的基础上进行早期血液灌流。观察对比治疗前后两组患者意识障碍改善时间、住院时间、阿托品总用量、72 h内氯磷定总用量，治愈率、反跳率和阿托品中毒率，以及治疗前后尿素氮(BUN)、尿肌酐(Cr)、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、乳酸脱氢酶(LDH)、磷酸肌酸激酶(CPK)和肌酸激酶同工酶(CK-MB)以及治疗7 d内的血清胆碱酯酶活性变化水平。结果观察组意识障碍改善时间[(5.6±1.3)h]、住院时间[(13.2±4.1)d]显著短于对照组[(7.9±2.6)h、(19.6±5.7)d]，观察组阿托品总用量[(7.4±2.3)mg]、72 h内氯磷定总用量[(22.7±7.2)mg]也明显少于对照组[(18.4±5.3)mg、(38.5±8.1)mg]，两组组间比较差异均有高度统计学意义(均P约0.01)；观察组治愈率(100.0%)显著高于对照组(90.5%)，观察组反跳率(14.3%)、阿托品中毒率(4.8%)显著低于对照组(33.3%、28.6%)，两组组间比较差异均有高度统计学意义(均P约0.01)。治疗后观察组BUN[(7.1±1.1)mmol/L]、Cr[(112.9±8.4)μmol/L]、AST[(45.1±3.9)U/L]、ALT[(45.1±5.3)U/L]、LDH[(164.3±14.6)U/L]、CPK[(167.4±5.6)U/L]、CK-MB[(28.5±5.4)U/L]水平均显著低于对照组的BUN[(13.2±3.3)mmol/L]、Cr [(148.3±11.2)μmol/L]、AST [(89.4±7.3)U/L]、ALT [(78.3±6.3) U/L]、LDH [(204.2±17.9) U/L]、CPK [(181.3±7.8)U/L]、CK-MB[(39.4±6.1)U/L]水平，两组组间比较差异均有统计学意义(均P约0.05)；治疗1、3、5、7 d观察组胆碱酯酶活性变化值[(214.3±21.3)、(296.8±54.1)、(482.1±71.3)、(649.7±131.2)U/L]均显著低于对照组在这4个时间段的胆碱酯酶活性变化值[(303.1±27.5)、(631.5±48.9)、(913.7±89.2)、(1573.4±157.4)U/L]，两组组间4个时段比较，差异均有高度统计学意义(均P约0.01)。结论早期血液灌流能够加速急性毒死蜱中毒患者胆碱酯酶复活速度，保护机体主要器官功能，减少解毒药的用量，值得临床推广。
    목적：탐토급성독사비중독환자적창구급후기호리조시。방법선취2011년7월~2014년7월재절강성저파시의료중심리혜리의원구치적42례급성독사비중독환자작위연구대상，장전부입선병례수궤분위관찰조(21례)화대조조(21례)，대조조채용상규치료방법，관찰조재대조조적기출상진행조기혈액관류。관찰대비치료전후량조환자의식장애개선시간、주원시간、아탁품총용량、72 h내록린정총용량，치유솔、반도솔화아탁품중독솔，이급치료전후뇨소담(BUN)、뇨기항(Cr)、천문동안산안기전이매(AST)、병안산안기전이매(ALT)、유산탈경매(LDH)、린산기산격매(CPK)화기산격매동공매(CK-MB)이급치료7 d내적혈청담감지매활성변화수평。결과관찰조의식장애개선시간[(5.6±1.3)h]、주원시간[(13.2±4.1)d]현저단우대조조[(7.9±2.6)h、(19.6±5.7)d]，관찰조아탁품총용량[(7.4±2.3)mg]、72 h내록린정총용량[(22.7±7.2)mg]야명현소우대조조[(18.4±5.3)mg、(38.5±8.1)mg]，량조조간비교차이균유고도통계학의의(균P약0.01)；관찰조치유솔(100.0%)현저고우대조조(90.5%)，관찰조반도솔(14.3%)、아탁품중독솔(4.8%)현저저우대조조(33.3%、28.6%)，량조조간비교차이균유고도통계학의의(균P약0.01)。치료후관찰조BUN[(7.1±1.1)mmol/L]、Cr[(112.9±8.4)μmol/L]、AST[(45.1±3.9)U/L]、ALT[(45.1±5.3)U/L]、LDH[(164.3±14.6)U/L]、CPK[(167.4±5.6)U/L]、CK-MB[(28.5±5.4)U/L]수평균현저저우대조조적BUN[(13.2±3.3)mmol/L]、Cr [(148.3±11.2)μmol/L]、AST [(89.4±7.3)U/L]、ALT [(78.3±6.3) U/L]、LDH [(204.2±17.9) U/L]、CPK [(181.3±7.8)U/L]、CK-MB[(39.4±6.1)U/L]수평，량조조간비교차이균유통계학의의(균P약0.05)；치료1、3、5、7 d관찰조담감지매활성변화치[(214.3±21.3)、(296.8±54.1)、(482.1±71.3)、(649.7±131.2)U/L]균현저저우대조조재저4개시간단적담감지매활성변화치[(303.1±27.5)、(631.5±48.9)、(913.7±89.2)、(1573.4±157.4)U/L]，량조조간4개시단비교，차이균유고도통계학의의(균P약0.01)。결론조기혈액관류능구가속급성독사비중독환자담감지매복활속도，보호궤체주요기관공능，감소해독약적용량，치득림상추엄。
    Objective To explore the rescue and late nursing method of patients with acute poisoning of chlorpyrifos. Methods During July 2011 to July 2014, 42 cases of patients with acute poisoning of chlorpyrifos were selected as the object of study, all the patients were randomly divided into two groups: the observation group (21 cases) and control group (21 cases). The control group was given routine treatment, the observation group was given early hemoperfusion treatment on the basis of the control group. Two groups of patient's index including improvement time for consciousness disturbance, hospitalization time, total dosage of Atropine, total dosage of Pralidoxime Chloride in 72 h; cure rate, bounce rate, poisoning rate of atropine; activity changes of blood urea nitrogen (BUN), urinary creatinine (Cr), aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), creatine kinase (CPK), creatine kinase isoenzyme (CK-MB), and serum cholinesterase in 7 days of treatment were observed and compared. Results The improvement time for consciousness obstacle and the hospitalization time in the observation group [(5.6±1.3) h, (13.2±4.1) d] were significantly shorter than those of the control group [(7.9±2.6) h, (19.6±5.7) d], the total dosage of Atropine and the total dosage of Pralidoxime Chloride in 72 h in the observation group [(7.4±2.3), (22.7±7.2) mg] were significantly less than those of the control group [(18.4±5.3), (38.5±8.1) mg], the differences between the two groups were statistically sig-nificant (all P< 0.01); the cure rate in the observation group (100.0%) was significantly higher than that of the control group (90.5%), the bounce rate, atropine poisoning rate in the observation group (14.3%, 4.8%) were significantly lower than those of the control group (33.3%, 28.6%), the differences between the two groups were statistically significant (all P<0.01);the level of BUN, Cr, AST, ALT, LDH, CP, KCK-MB in the observation group [(7.1±1.1) mmol/L, (112.9±8.4)μmol/L, (45.1±3.9) U/L, (45.1±5.3) U/L, (164.3±14.6) U/L, (167.4±5.6) U/L, (28.5±5.4) U/L] after treatment were significantly low-er than those of the control group [(13.2±3.3) mmol/L, (148.3±11.2) μmol/L, (89.4±7.3) U/L, (78.3±6.3) U/L, (204.2±17.9) U/L, (181.3±7.8) U/L, (39.4±6.1) U/L], the differences between the two groups were statistically significant (all P<0.05); the changes of cholinesterase activity after 1, 3, 5, 7 d of treatment in the observation group [(214.3±21.3), (296.8±54.1), (482.1±71.3), (649.7±131.2) U/L] were higher than those of the control group [(303.1±27.5), (631.5±48.9), (913.7±89.2), (1573.4±157.4) U/L], the differences in each period between the two groups were statistically significant (all P< 0.01). Conclusion Early hemoperfusion can accelerate the resurrection speed of cholinesterase in patients with acute poisoning of chlorpyrifos, and protect the function of main organs in the body, reduce the amount of antidote. It is worthy of clinical promotion.
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