标题：盐酸戊乙奎醚联合血液灌流治疗急性重度有机磷中毒的疗效及其对患者炎性因子和氧化应激的影响

      作者：王文坤 1，陈建洪 1，陈金新 2    (中国人民解放军第九五医院急诊科 1、肾内血液科 2，福建 莆田 351100)

      卷次： 2018年29卷20期

      【摘要】 目的 观察盐酸戊乙奎醚(PHC)联合血液灌流治疗急性重度有机磷农药中毒的临床疗效及其对患者炎性因子和氧化应激的影响。方法 选择中国人民解放军第九五医院2013年1月至2017年12月间收治的70例急性重度有机磷中毒患者为研究对象，根据随机数表法分为观察组和对照组各35例。观察组应用盐酸戊乙奎醚联合血液灌流治疗，对照组仅应用血液灌流治疗，疗程7 d或至患者症状消失，比较两组患者的治疗效果以及治疗前和治疗72 h后的炎性因子和氧化应激水平。结果 观察组与对照组患者的氯磷定[(5.38±2.15) g vs (17.92±5.10) g]及阿托品总用量[(124.16±30.74) mg vs (278.05±80.15) mg]、胆碱酯酶恢复正常[(7.74±2.82) d vs (13.64±4.22) d]及平均住院时间[(9.54±3.08) d vs (17.25±4.82) d]比较，观察组均少于对照组，差异均有统计学意义(P<0.05)；观察组与对照组患者治疗后的 TNF-α [(89.17±18.51) vs (131.46±21.08) pg/mL]、IL-6 [(7.94±1.97) ng/mL vs (11.05±2.17) ng/mL]及 IL-8 [(73.05±15.31) ng/mL vs 95.04±16.07) ng/mL]水平比较，观察组均明显低于对照组，差异均有统计学意义(P<0.05)；治疗后，观察组与对照组患者的超氧化物歧化酶(SOD) [(531.31±41.08) U/mL vs (451.61±42.25) U/mL]和乳酸脱氢酶(LDH) [(2 988.61±366.34) vs (3 697.15±312.64) U/L]水平比较差异均有统计学意义(P<0.05)。结论 盐酸戊乙奎醚联合血液灌流能够明显减少阿托品的应用，阻断炎性因子的释放，降低氧化应激，可以有效的提高疗效。
      【关键词】 有机磷中毒；盐酸戊乙奎醚；血液灌流；阿托品；疗效
      【中图分类号】 R595.4 【文献标识码】 A 【文章编号】 1003—6350（2018）20—2833—04

Effect of penehyclidine hydrochloride combined with hemoperfusion in the treatment of acute severeorganophosphorus poisoning and its effect on inflammatory factors and oxidative stress in patients.
WANGWen-kun 1, CHEN Jian-hong 1, CHEN Jin-xin 2. Emergency Department 1, Intrarenal Department of Hematology 2, ChinesePeople's Liberation Army No. 95 Hospital, Putian 351100, Fujian, CHINA
【Abstract】 Objective To observe the clinical efficacy of Penehyclidine hydrochloride (PHC) combined withhemoperfusion in the treatment of acute severe organophosphorus pesticide poisoning and its effects on inflammatoryfactors and oxidative stress in patients. Methods Seventy patients with acute severe organophosphorus pesticide poi-soning who were admitted to the Chinese People's Liberation Army No. 95 Hospital from Jan. 2013 to Dec. 2017 wereselected as the subjects. According to the random number table method, they were divided into observation group andcontrol group (35 cases in each group). The observation group was treated with PHC combined with hemoperfusion, andthe control group was only treated with hemoperfusion. The course of treatment was 7 days or until the patient's symp-toms disappeared. The therapeutic effect of the two groups was compared, as well as the levels of inflammatory factorsand oxidative stress before and 72 h after treatment. Results The total dosage of pralidoxime chloride and atropineused, mean time of cholinesterase recovery, hospital stay in the the observation group versus the control group were(5.38±2.15) g vs (17.92±5.10) g, (124.16±30.74) mg vs (278.05±80.15) mg, (7.74±2.82) d vs (13.64±4.22) d, (9.54±3.08) dvs (17.25±4.82) d, and the differences were statistically significant (P<0.05). The levels of TNF-α, IL-6, and IL-8 in theobservation group were significantly lower than those in the control group after treatment: (89.17±18.51) vs (131.46±21.08) pg/mL, (7.94±1.97) ng/mL vs (11.05±2.17) ng/mL, (73.05±15.31) ng/mL vs 95.04±16.07) ng/mL, and the differ-ences were statistically significant (P<0.05). After treatment, the levels of superoxide dismutase (SOD) and lactate dehy-drogenase (LDH) also showed statistically significant difference between the two groups (P<0.05): (531.31±41.08) U/mLvs (451.61±42.25) U/mL, (2 988.61±366.34) vs (3 697.15±312.64) U/L. Conclusion Penehyclidine hydrochloride com-bined with hemoperfusion can significantly reduce the application of atropine, block the release of inflammatory factors,reduce oxidative stress, and effectively improve the curative effect.
      【Key words】 Organophosphorus poisoning; Penehyclidine hydrochloride; Hemoperfusion; Atropine; Clinicaleffect·论 著·doi:10.3969/j.issn.1003-6350.2018.20.007