| Objective:To observe the hemoperfusion(HP)clinical curative effect for the treatment of acute severe organophosphorus pesticide poisoning(AOPP).Methods:82 cases of acute severe organophosphorus pesticide poisoning in hospital from September,2008 to September,2011 Patients were divided into treatment group(HP group)and non hemoperfusion group(Non HP group),HP group received traditional treatment methods including gastrolavage,catharsis,vomiting,atropine and pralidoxime in chloride.HP group at HP and traditional treatment.Observe all the patients’ ingested dosage,the patients’ general condition,type of drug poisoning,treatment time after poisoning,cholinesterase(CHE)activity,blood Creatinine,arterial blood oxygen partial pressure;the incidence of acute respiratory failure.Observe the survived patients:duration of the recovery of CHE activity,and assessment in the process of the two groups of patients in the treatment of time to atropinization、the dosage of atropine when arrived at atropinization、pralidoxime chloride dosage、the cumulative dosages of atropine in the hospital and the incidence of intermediate syndrome(IMS)、mechanical ventilation time、APACHE Ⅱ score,record allthe patients’ duration of being in hospital and the mortality,The above data evaluate HP rescue effect of organophosphorus pesticide poisoning.The changes of WBC counts、PLT counts、Hb concertration and metaglobulin level before and after perfusion were recorded to assess the effect of HP on blood cell and blood coagulation system;Record HP treatment process in 10 minutes,60 minutes,120 minutes of mean arterial pressure and other adverse reactions.Hospital mortality and patient outcome as dependent variables,To analyze the risk factors affecting the prognosis of patients,and to observe the incidence of HP related complications in HP group.Results:Compared with the Hp group,there was no difference in gender,toxic dose,pesticide poisoning type(P>0.05).Two groups of patients with respiratory failure incidence、poisoning to start rescue time、cholinesterase activity on admission to compare differences had no statistical significance(P>0.05).Compared with the non-hemoperfusion group,patients with hemoperfusion group atropine time[(4.54±0.9)h VS(5.24±0.8)h].serum cholinesterase recovery normal time[(9.54±1.1)d VS(11.3±1.5)d]、time at the hospital[(10.5±1.2)d VS(13.44±2.1)d]are shortened,arrive time to atropinization dosage of atropine[(262.1±29.7)mg VS(294.88±31.6)mg]is reduced,the difference was statistically significant(P<0.05).the incidence of intermediate syndrome[12.2%(5/41)VS 19.5%(8/41)],mechanical ventilation time[(4.06±0.68)dVS(5.01±0.60)d]、total atropine dosage[(801.9±91.4)mg VS(974.4±87.3)mg]significantly decreased(P<0.01),Between the two groups of pralidoxime chloride dosage HP group(17.89±5.98)VS non-HP group(21.75±6.22)the difference was statistically significant(P<0.05).Death risk factors analysis showed:death group VS survive group at age(58.6±17.3)VS(42.8±12.5),drug dosage(188.7±28)VS(78.9±32.7),The initial cholinesterase activity(235±55.4)VS(809.2±588.9),complications and APACHEII scores(18,8±9,9)VS(7.9±6.3)is closely related to the patients(P<0.01).HP may affect prognosis.HP may not affect the Hb concentraIion level.HP affect the amount of blood pressure、white blood cells(14.7±5.1)VS(12.6±4.8)、platelets(208±43.9)VS(179±55.4)、and metaglobulin level(2.85±1.15)VS(3.38±1.26)(P<0.05).Conclusions:1.Hemoperfusion can reduce the dosage of atropine、shorten the time to atropinization,HP treatment of AOPP can shorten the recovery time and shorten the time of hospitalization.2.HP methods can sightly reduce the incidence of IMS patients.Shorten mechanical ventilation time.3.HP has a little influence on blood pressure and a part of blood component,but does not affect the treatment. |
