Analysis Of Clinical Efficacy On Different Blood Purifications In Patients With Acute Severe Organophosphorus Pesticide Poisoning

ObjectiveOrganophosphorus pesticide is one of the most common used pesticides in Chinese rural areas. As a result, organophosphorus pesticide poisoning is usually associated with medical emergencies in the clinics of these areas. Traditional treatment for mild and moderate organophosphorus pesticide poisoning can achieve the desired effect, but treatment effect is not good to severe organophosphorus pesticide poisoning. Recent years, blood purification is more and more used in severe organophosphorus pesticide poisoning, which provides a more effective treatment for clinical treatment. The present study was to investigate the efficacy of the hemoperfusion(HP) combined with plasma exchange(PE) in the treatment of acute severe organophosphorus pesticide poisoning. MethodsTotal of 91 patients with acute severe organophosphorus pesticide poisoning admitted to Xijing hospital from December 2012 to December 2014 were divided into conventional treatment group(CTG), hemoperfusion group(HPG) and hemoperfusion with plasma exchange group(HEG). General admission, clinical efficacy, complications, blood biochemical index, plasma cholinesterase activity, inflammatory factors including TNF-α, IL-1β, IL-6 and IL-8 before and after treatment of all patients were statistical analyzed. ResultsThere was no significant difference between the groups in general condition. In patients of HPG and HEG, the cure rate was significantly improved while total dosage of atropine and pralidoxime chloride, total amount of hospitalization, and duration of coma were significantly decreased compared to those in CTG(P<0.05). Moreover, duration of coma, total dosage of atropine and pralidoxime chloride of HEG were decreased as compared with those in the HPG(P<0.05). The creatinine and amylase of HEG were decreased significantly compared with those of CTG, HPG and before treatment(P<0.05). Alanine aminotransferase of HEG was shown to decrease after treatment but not different from that of HPG. HPG and HEG showed significantly increased plasma cholinesterase activity at 4h, 24 h and 72 h after admission compared with CTG(P<0.05). While plasma cholinesterase activity of HEG was higher than that of HPG 24 h after treatment. Complications in HEG were significantly decreased compared with CTG and HPG(P<0.05). HEG showed significantly decreased plasma inflammatory factor including TNF-α, IL-1β, IL-6 and IL-8 compared to CTG and HPG 4h and 24 h after treatment(P<0.05). ConclusionHP in treatment with acute severe organophosphorus pesticide poisoning is effective which is improved by together with PE. It can protect liver, kidney and pancreatic function. Moreover, it increases cholinesterase activity quickly and decreases complications. The potential mechanism may be related to reducing the inflammatory factors. But PE treatment is too expensive to carry out in all of the basic level hospitals.