血液灌流治疗急性有机磷农药中毒中间综合征的疗效研究
作者：于笑霞 王立新 吕增禄 胡春华 马金荣 田俊阁
单位：于笑霞 王立新 吕增禄 马金荣 田俊阁(061001 河北省沧州中西医结合医院肾内科)；胡春华(公安部第二研究所)
关键词：血液灌流；中间综合征；中毒；有机磷农药
中华肾脏病杂志000306摘 要：目的探讨血液灌流对急性有机磷农药中毒中间综合征(IMS)患者血中有机磷的清除作用及临床疗效。方法20例IMS患者随机分为灌流组和非灌流组。灌流组在综合治疗基础上，除用解磷定外，同时予以血液灌流治疗，并用固相萃取技术进行色谱定量分析灌流前后患者血中有机磷含量。非灌流组在综合治疗基础上单用解磷定。通过观察灌流前后血中有机磷含量的变化、存活率、IMS病程及呼吸肌麻痹发生率4项指标来判断血液灌流的临床疗效。结果灌流组存活率100%，显著优于非灌流组(30%，P<0.01)。IMS病程明显短于非灌流组(P<0.05)。血液灌流后无一例发生呼吸肌麻痹，非灌流组均出现呼吸肌麻痹。8例血液灌流2h有机磷清除率为100%，2例灌流1h清除率分别为80.1%和65.5%。结论血液灌流能有效清除体内有机磷。血液灌流治疗急性有机磷农药中毒中间综合征疗效显著。
, 百拇医药
Efficacy study of hemoperfusion in treating intermediate syndrome following acute organophosphorus pesticide poisoning
YU Xiaoxia,Wang Lixin,LU Zenglu
(Department of Nephrology, Hebei Cangzhou Traditional Chinese Medicine-Western Medicine Hospital, Hebei Cangzhou 061001, China)
Abstract：Objective To investigate the clearance of organophosphorus pesticide(OP) by hemoperfusion from the blood of patients with intermediate syndrome (IMS) following acute organophosphorus pesticide poisoning (AOPP) and its clinical efficacy. Methods Twenty cases with IMS following AOPP were divided randomly into hemoperfusion group and non-hemoperfusion group. The hemoperfusion group was treated with pralidoxime plus hemoperfusion. Organophosphorus pecticide blood concentration was detected before and after hemoperfusion. The non-hemoperfusion group was treated with pralidoxime alone. The following parameters were observed: changes of OP blood concentration after hemoperfusion, survival rate, clinical course, incidence of paralysis of respiratory muscles. Results In hemoperfusion group, the surviral rate was 100%, markedly superior to non-hemoperfusion group (30%, P<0.01); the clinical course of IMS was significantly shorter than that of non-hemoperfusion group(P<0.05); no case with paralysis of respiratory muscles was found. Clearance rate of organophosphorus pesticide was 100% in 8 cases with 2 hours hemoperfusion, 80.1% , 65.5% in 2 cases with 1 hour hemoperfusion. Conclusions Hemoperfusion is an effective therapy for removing organophosphorus pesticide from the blood. There is an obvious efficacy of hemoperfusion in treating IMS following AOPP.
, 百拇医药
Keywords：Hemoperfusion; Intermediate symdrome; Poisoning; Organophosphorus pesticide
参考文献：
[1]Senanayake N, Karalliedde L. Neurotoxic effects of organophosphorus insecticides: an intermediate syndrome. N Engl J Med, 1987, 316: 761-763.
[2]De Bleecker JL, Van Den Neucker K, Colardyn F. Intermediate syndrome in organophosphorus poisoning: a prospective study. Crit Care Med, 1993, 21: 1706-1711.
, 百拇医药
[3]Fengsheng He, Haibing Xu, Fukuang Qin, et al. Intermediate myasthenia syndrome following acute organophosphates poisoning. an analysis of 21 cases. Human Exp Toxicot, 1998, 17, 40-45.
[4]王汉斌，赵德禄.急性有机磷农药中毒呼吸衰竭的形成与救治.中华内科杂志，1995，34：365-366.
[5]王汉斌，黄韶清.急性有机磷农药中毒致“中间综合征”4例报告及文献复习.军事医学科学院院刊，1995，19：34-37.
[6]李立君，赵德禄.乐果等中毒胆碱酯酶的老化和自动重活化.中华劳动卫生职业病杂志，1996，14：264-267.
[7]王汉斌，赵德禄，黄韶清.敌敌畏抑制离体大鼠膈肌的研究.中华劳动卫生职业病杂志，1997，15：172-173.
收稿日期：1999-08-20, 百拇医药
单位：于笑霞 王立新 吕增禄 马金荣 田俊阁(061001 河北省沧州中西医结合医院肾内科)；胡春华(公安部第二研究所)
关键词：血液灌流；中间综合征；中毒；有机磷农药
中华肾脏病杂志000306摘 要：目的探讨血液灌流对急性有机磷农药中毒中间综合征(IMS)患者血中有机磷的清除作用及临床疗效。方法20例IMS患者随机分为灌流组和非灌流组。灌流组在综合治疗基础上，除用解磷定外，同时予以血液灌流治疗，并用固相萃取技术进行色谱定量分析灌流前后患者血中有机磷含量。非灌流组在综合治疗基础上单用解磷定。通过观察灌流前后血中有机磷含量的变化、存活率、IMS病程及呼吸肌麻痹发生率4项指标来判断血液灌流的临床疗效。结果灌流组存活率100%，显著优于非灌流组(30%，P<0.01)。IMS病程明显短于非灌流组(P<0.05)。血液灌流后无一例发生呼吸肌麻痹，非灌流组均出现呼吸肌麻痹。8例血液灌流2h有机磷清除率为100%，2例灌流1h清除率分别为80.1%和65.5%。结论血液灌流能有效清除体内有机磷。血液灌流治疗急性有机磷农药中毒中间综合征疗效显著。
, 百拇医药
Efficacy study of hemoperfusion in treating intermediate syndrome following acute organophosphorus pesticide poisoning
YU Xiaoxia,Wang Lixin,LU Zenglu
(Department of Nephrology, Hebei Cangzhou Traditional Chinese Medicine-Western Medicine Hospital, Hebei Cangzhou 061001, China)
Abstract：Objective To investigate the clearance of organophosphorus pesticide(OP) by hemoperfusion from the blood of patients with intermediate syndrome (IMS) following acute organophosphorus pesticide poisoning (AOPP) and its clinical efficacy. Methods Twenty cases with IMS following AOPP were divided randomly into hemoperfusion group and non-hemoperfusion group. The hemoperfusion group was treated with pralidoxime plus hemoperfusion. Organophosphorus pecticide blood concentration was detected before and after hemoperfusion. The non-hemoperfusion group was treated with pralidoxime alone. The following parameters were observed: changes of OP blood concentration after hemoperfusion, survival rate, clinical course, incidence of paralysis of respiratory muscles. Results In hemoperfusion group, the surviral rate was 100%, markedly superior to non-hemoperfusion group (30%, P<0.01); the clinical course of IMS was significantly shorter than that of non-hemoperfusion group(P<0.05); no case with paralysis of respiratory muscles was found. Clearance rate of organophosphorus pesticide was 100% in 8 cases with 2 hours hemoperfusion, 80.1% , 65.5% in 2 cases with 1 hour hemoperfusion. Conclusions Hemoperfusion is an effective therapy for removing organophosphorus pesticide from the blood. There is an obvious efficacy of hemoperfusion in treating IMS following AOPP.
, 百拇医药
Keywords：Hemoperfusion; Intermediate symdrome; Poisoning; Organophosphorus pesticide
参考文献：
[1]Senanayake N, Karalliedde L. Neurotoxic effects of organophosphorus insecticides: an intermediate syndrome. N Engl J Med, 1987, 316: 761-763.
[2]De Bleecker JL, Van Den Neucker K, Colardyn F. Intermediate syndrome in organophosphorus poisoning: a prospective study. Crit Care Med, 1993, 21: 1706-1711.
, 百拇医药
[3]Fengsheng He, Haibing Xu, Fukuang Qin, et al. Intermediate myasthenia syndrome following acute organophosphates poisoning. an analysis of 21 cases. Human Exp Toxicot, 1998, 17, 40-45.
[4]王汉斌，赵德禄.急性有机磷农药中毒呼吸衰竭的形成与救治.中华内科杂志，1995，34：365-366.
[5]王汉斌，黄韶清.急性有机磷农药中毒致“中间综合征”4例报告及文献复习.军事医学科学院院刊，1995，19：34-37.
[6]李立君，赵德禄.乐果等中毒胆碱酯酶的老化和自动重活化.中华劳动卫生职业病杂志，1996，14：264-267.
[7]王汉斌，赵德禄，黄韶清.敌敌畏抑制离体大鼠膈肌的研究.中华劳动卫生职业病杂志，1997，15：172-173.
收稿日期：1999-08-20, 百拇医药