Ulinastatin Combined With Hemoperfusion For The Treatment Of Acute Severe Organophosphorus Pesticide Poisoning Clinical Efficacy Observation

Objective: To observe the clinical efficacy of ulinastatin(UTI)combined with hemoperfusion(HP)in patients with acute severe organophosphorus pesticide poisoning(ASOPP).Methods: A total of 62 patients with ASOPP admitted to the Affiliated Hospital of Jining Medical College from January 2016 to October 2018 were enrolled.The two groups were eligible for ASOPP and were randomly divided into experimental groups(32 patients).And the control group(30 cases),the two groups of patients were given routine treatment +HP immediately after admission,the experimental group was given ulinastatin on the basis of this treatment.The general conditions of the two groups were compared,the time of taking the drug to the start of treatment,the APACHE II score before treatment,the activity of cholinesterase,the time of mechanical ventilation,the number of hospital stays,complications and mortality.The dynamic changes of biochemical parameters(cholinesterase,high-sensitivity C-reactive protein)before and after treatment were compared between the experimental group and the control group.The patients in the two groups were compared before and after treatment.The levels of inflammatory mediators tumor necrosis factor-a(TNF-a)and interleukin-6(IL-6)were analyzed,and the main risk factors leading to death were analyzed.Results: There were no significant differences in gender,age,amount of poisoning,duration of treatment,duration of treatment,and type of poisoning drugs between the two groups(P > 0.05).There were no significant differences in cholinesterase activity and blood amylase between the two groups(P > 0.05).The activities of cholinesterase at 3d and 5d after treatment were significantly higher than those before treatment,but there was no significant difference between the two groups(P>0.05).The levels of TNF-a,IL-6,high-sensitivity C-reactive protein in the experimental group and the control group were lower than those before treatment.The difference between the two groups was statistically significant(P<0.05).The incidence and mortality of respiratory failure and MODS in the experimental group were significantly lower than those in the control group(P < 0.05).The mechanical ventilation time and hospitalization days of the experimental group were significantly lower than the control group(P < 0.05).The age of the patients who died,the dose of the drug,the time of taking the drug to the beginning of treatment,and the APACHE II score were significantly higher than those of the surviving patients(P<0.05).The cholinesterase activity of the patients before death was significantly lower than that of the surviving patients(P<0.05).Conclusion: On the basis of routine treatment,UTI combined with HP in the treatment of acute severe organophosphorus pesticide poisoning can not only quickly remove toxic substances,but also significantly reduce the systemic inflammatory response of patients,thus protecting organ function,reducing the occurrence of MODS,improving clinical efficacy and reducing the mortality of patients.Age,dosage,time from poisoning to the beginning of treatment,APACHE II score and the activity of cholinesterase before treatment are the main risk factors leading to death,which should be paid attention to in clinical rescue.