Clinical analysis of atropine combined with continuous veno-venous hemofiltration and hemoperfusion in the treatment of acute severe organophosphate poisoning in the elderly
Objective To analyze the effects of atropine combined with continuous veno-venous hemofiltration(CVVH)and hemoperfusion(HP)in the treatment of acute severe organophosphate poisoning in the elderly.Methods 64 elderly pa-tients with acute severe organophosphorus poisoning treated in First People's Hospital of Zigong City from January 2019 to Janu-ary 2022 were retrospectively selected.According to different treatment plans,they were divided into control group(32 cases,treated with atropine)and observation group(32 cases,treated with atropine combined with CVVH+HP regimen).Both groups received routine first aid measures such as repeated cleaning of the stomach,induction of diarrhea with mannitol or mag-nesium sulfate,extensive oxygen inhalation,electrolyte balance,and use of cholinesterase(ChE)reactivator pralidoxime chlo-ride.In addition,the control group was treated with atropine,and the observation group was treated with atropine combined CVVH+HP.The recovery condition,the ChE level,and the evaluation values of the degree of cardiac,liver and kidney func-tion injury[cardiac function indexes:cardiac troponin I(cTnI),cardiac troponin T(cTnT),creatine kinase isoenzyme(CK-MB);liver function indexes:alanine aminotransferase(ALT),aspartate aminotransferase(AST);renal function inde-xes:urinary protein quantification,urea nitrogen,blood creatinine)]of the two groups were observed and compared.The de-gree of oxidative stress[the levels of human lipid peroxide(LPO),malondialdehyde(MDA),superoxide dismutase(SOD)],local inflammation[the levels of interleukin-1β(IL-1β),interleukin-6(IL-6),procalcitonin(PCT)],as well as adverse events,clinical efficacy and incidence of severe complications during remission of the two groups were observed and compared.Results Compared with the control group,the awake time,mechanical ventilation time,ChE activity recovery time and hospitalization time of the observation group were significantly shortened(P＜0.05).After treatment,the ChE level of the two groups was higher than that of the same group before treatment,and the observation group was higher than the con-trol group,with statistical significance(P＜0.05).After treatment,the levels of CK-MB,cTnI,cTnT,ALT,AST,urine protein,urea nitrogen,and blood creatinine of the two groups were lower than those of the same group before treatment,and the observation group were lower than the control group,with statistical significance(P＜0.05).After treatment,the levels of LPO and MDA of the two groups were lower than those of the same group before treatment,while the level of SOD of the two groups was higher than that of the same group before treatment;the improvement amplitude of above indexes of the observation group were greater than that of the control group(P＜0.05).After treatment,the levels of IL-1β、IL-6 and PCT were lower than those of the same group before treatment,and the observation group were significantly lower than the control group(P＜0.05).Compared with the control group,the incidence of adverse events in the observation group decreased,while the effica-cy increased,and the differences were statistically significant(P＜0.05).Compared with the control group,the incidence of severe complications such as IMS and rebound decreased in the observation group,but there was no statistical significance be-tween the two groups(P＞0.05).Conclusion The combination of atropine and CVVH+HP regimen can reduce the occur-rence of related complications in elderly patients with acute severe organophosphorus poisoning,promote the expression of ChE,inhibit local inflammation,enhance antioxidant capacity,and reduce the damage to organ functions.It has a good thera-peutic effect and certain clinical application value.
elderlyacute severe organophosphorus poisoningatropinecontinuous veno-venous hemofiltrationhemoperfusion
国家科技期刊平台
NSTL
万方数据
维普
