| Objective: To observe the clinical efficacy of different modes of hemoperfusion(HP)combined with continuous renal replacement therapy(CRRT)in the treatment of acute severe organophosphorus pesticide poisoning(ASOPP).Methods: Sixty-three ASOPP patients hospitalized in Qingzhou Hospital Affiliated to Taishan Medical University between December 2014 and February 2017 were selected as subjects,who were randomly divided into enhanced group(n = 30)and routine group(n= 33).Immediately after admission,both two groups received routine treatment;including: gastric lavage and using routine medicine;on this basis,different modes of HP + CRRT were performed.According to the patient’s awareness and blood gas analysis,it decided whether to give oral tracheal intubation using breathing ventilator-assisted,breathing,cardiac arrest patients,it start cardiopulmonary resuscitation immediately.routine group applications HP once a day,every 2h,for 3consecutive days,enhanced group applications HP in the first day of each 8h for 1 time,every 2h,the second day each 12 h for 1 time,every 2h,the third day only for 1time,every 2h.using SPSS 19.0 software package for statistical analysis,the measurement data is expressed as x ± s,t-test is used to the comparison between different group,treatment of different periods of cholinesterase activity data analysis use repeated measurement of variance analysis,the count data use X2 test,P < 0.05 was significant.General situation,duration from poisoning to the beginning of treatment,APACHEII score before treatment,dosage of conventional drugs,biochemical indicators,cholinesterase activity,the number of cases with respiratory failure,duration of ventilation,duration of hospital stay,complications and mortality were compared between the two groups.In addition,dosage of poison,APACHEII score,duration from poisoning to the beginning of treatment and cholinesterase activity were compared between patients who died and survived,to preliminarily analyze factors affecting patients’ death.Results: Gender,age,toxic drugs,toxic dose and duration from poisoning to rescue in the two groups showed no statistically significant differences(P > 0.05),suggesting comparability.Compared with the routine group,the dosage of conventional drugs was significantly lower(P < 0.05)and the duration of ventilation and hospital stay were evidently shorter(P < 0.01)in the enhanced group.No statistical difference was found in cholinesterase activity before treatment between the two groups(P > 0.05);at the 3rd and5 th day after treatment,cholinesterase activity in the enhanced group was apparently higher than that in the routine group(P < 0.01).Except respiratory failure complication rates and mortality in the enhanced group were obviously lower than those in the routine group(P < 0.05).In the patients who died,dosage of poison,APACHEII score,duration from poisoning to gastric lavage were significantly higer as compared with the patients who survived(P < 0.05).Conclusion:Enhanced HP combined with CRRT presents good efficacy and high safety in the treatment of ASOPP;the total application time and mechanical ventilation time,the number of hospital stay were significantly decreased.cholinesterase activity recovery faster.Mortality and complication of the patients decreased significantly Dosage of poison,APACHEII score,duration of treatment,and cholinesterase activity may be the risk factors for death;therefore,attention should be paid to them in treatment.Significance:Blood purification is an effective measure for the treatment of poisoning patientscurrently.The research about the different number in the treatment of acute severe organophosphate poisoning patients who should use HP combined with CRRT on the final clinical outcome is rare,and the most of the daily clinical work depends on experience treatment,The results of this research show the treatment of enhanced HP combined with CRRT is a safe and effective treatment program,it is simple and easy,worth to be promoted. |
PDF Full Text Request