血液灌流联合预防性气管插管抢救急性重度有机磷农药中毒临床对比探究.docVIP

血液灌流联合预防性气管插管抢救急性重度有机磷农药中毒临床对比探究【摘要】目的：观察不同时机气管插管与血液灌流(HP)对急性重度有机磷农药中毒(AOPP)预后的影响。方法：出现早期呼吸功能不全的AOPP患者53例，随机分为两组，治疗组（28例）预防性气管插管并行血液灌流治疗；对照组（25例） 呼吸衰竭后才行气管插管和血液灌流。记录两组预后情况、并发症发生情况。结果：治疗组死亡率3.6%，对照组为24.0%，治疗组肺部感染发生率为3.6%，对照组为36%。组间比较差异有统计学意义。结论：对AOPP患者出现早期呼吸衰竭时，预防性气管插管联合HP治疗，能有效地减少并发症的发生并改善预后。 【关键词】有机磷中毒；血液灌流；气管插管；预后 文章编号：1009-5519（2008）05-0638-02 中图分类号：R5 文献标识码：A Comparative study of hemoperfusion combined with preventive tracheal intubation in the emergency treatment of severe acute organophosphorus pesticide poisoning LI Jin-song （Intensive Care Unit，The Fourth People’s Hospital of Zigong，Sichuan 643000，China） 【Abstract】Objective：To investigate the effect of tracheal intubation in different opportunities and hmoperfusion on prognosis of severe acute organophosphorus pesticide poisoning(AOPP). Methods：53 cases of AOPP with early respiratory insufficiency were divided into two groups randomly.28 cases were treated with preventive tracheal intubation and hemoperfusion as group A，while 25 cases with tracheal intubation and hemoperfusion only after respiratory failure onset.The prognosis and complications in two groups were recorded. Results：The mortality and incidence of complication were 3.6% and 3.6% respectively in group A，and 24% and 36% respectively in group B，with significant difference in the mortality between two groups. Conclusion：Preventive tracheal intubation combined with hemoperfusion can effectively improve the prognosis and decrease the incidence of complications on the AOPP patients with early respiratory failure. 【Key words】Organophosphorus poisoning；Hemoperfusion；Tracheal intubation；Prognosis 急性有机磷农药中毒(Acute organophorus pesticides，AOPP) 是我国急性中毒中危害最大的疾病之一，虽然随着阿托品的正规应用及早期足量使用复能剂，抢救重度AOPP的成功率已大幅度提升，但其死亡率仍高达26.2%[1]。为提高抢救成功率及减少并发症，我院2003年1月~2006年12月对28例重度AOPP患者进行预防性气管插管与血液灌流，取得了良好的效果，现报道如下： 1 资料与方法 1.1 临床资料：53例为重度AOPP患者，均符合AOPP诊断及分度标准[2]。服毒量50~400 ml，服毒种类有敌敌畏、甲胺磷、乐果、氧化乐果、对硫磷及混合农药等，服毒至就诊时间0.5~4 h。服毒后6 h~3 d出现睁眼及吞咽困难18例，声音