| Objective To analyze the clinical effects of two different hemoperfusion devices,namely charcoal kidney hemoperfusion device and resin hemoperfusion device,on patients with acute severe organophosphorus pesticide poisoning.Methods Retrospective analysis was performed on severe organophosphorus poisoning patients who underwent hemoperfusion in the icu of the general hospital of Ningxia Medical University from January 2008 to December 2017.The patients were divided into charcoal kidney group and resin group by different hemoperfusion devices.All patients were treated with gastric lavage and catharsis after admission,and were given early choline receptor antagonist and cholinesterase regenerative agent.At the same time,according to the condition,the corresponding symptomatic treatment was carried out;then hemoperfusion treatment was performed as soon as possible.The clinical cure criteria were chosen as follows: the symptoms of patient poisoning basically disappeared,and the plasma cholinesterase activity was above 60%.General patient data,time from poisoning to gastric lavage,whole blood cholinesterase and platelets before and after hemoperfusion,length of hospital stay,cost,time of transfer out of the intensive care unit,complications,and death were taken as clinical observation indicators and statistics were performed.Learning analysis.Statistical analysis of the research data was performed using SPSS 22.0 software.Results There was no significant difference between the charcoal kidney group and resin group in general data such as gender,age,toxicological classification,toxic dose,timefrom poisoning to gastric lavage,time from poisoning to use of antidote,and time from poisoning to hemoperfusion(P >0.05).The difference in the number of hemoperfusion was statistically significant(P <0.05).The dosage of penehyclidine and chlorophosphate in the resin group was smaller than that in the charcoal kidney group(P <0.05),which was not related to the number of hemoperfusion.The proportion of mechanical ventilation,the average time of mechanical ventilation,the average time of transfer out of the icu and the hospitalization cost in the resin group were all lower than those in the carbonized kidney group(P <0.05).The cholinesterase activity in the resin group was significantly higher than that in the charcoal kidney group on the third and fifth days of treatment,and the difference was statistically significant(P <0.05).The degree of platelet level injury in the resin group was lower than that in the charcoal kidney group after treatment(P <0.05),and the difference was statistically significant.After treatment,liver function(alanine glutamate transaminase,straw glutamate transaminase)in the resin group was improved to a higher degree than that in the carbonized kidney group(P <0.05).Further stratified analysis was performed on the number of patients receiving hemoperfusion therapy.The cholinesterase activity in the resin group was significantly higher than that in the charcoal kidney group on the third and fifth days after the first and second hemoperfusion therapy(P <0.05).After hemoperfusion for 3times,the cholinesterase activity in the resin group was significantly higher than that in the charcoal kidney group on day 5(P <0.05).The platelet level of the resin group was higher than that of the carbonized kidney group only on day 7(P <0.05).After two hemoperfusion treatments,the platelet level in the resin group was higher than that in the charcoal kidney group on day 1,day 3 and day 7,and the difference was statistically significant(P<0.05).After hemoperfusion for 3 times,the platelet level in the resin group was lower than that in the charcoal kidney group(P <0.05).After two hemoperfusion treatments,alanine aminotransferase in the resin group was lower than that in the charcoal kidney group on the third and fifth days after treatment(P <0.05).After 3 times of hemoperfusion treatment,alanine aminotransferase was compared between the two groups.The results showed that the phase of the resin group was lower than that of the carbonated kidney group(P <0.05)only 3days after treatment.On the third day after the first hemoperfusion treatment,the liver function of the patients in the resin group was less damaged than that in the charcoal kidney group(P<0.05).After two hemoperfusion treatments,the glutamate transaminase of the resin group was lower than that of the charcoal kidney group on the third day,the fifth day and the seventh day(P <0.05).After three hemoperfusion treatments,the glutamate transaminase of the resin group was lower than that of the carbonated kidney group on the third day of treatment(P <0.05).In addition to mechanical ventilation,the cure rate of the resin group was higher than that of the charcoal kidney group and the incidence of IMS was lower than that of the charcoal kidney group(P <0.05),but there was no significant difference between the resin group and the charcoal kidney group in terms of delayed neuropathy and mortality(P >0.05).Conclusion Resin perfusion apparatus is better than charcoal kidney perfusion apparatus in the treatment of acute severe organophosphorus pesticide poisoning.Compared with charcoal kidney perfusion apparatus,the application of resin perfusion apparatus in the treatment of acute severe organophosphorus pesticide poisoning patients can reduce the dose of anticholinergic antagonist and antidote,shorten the recovery time of cholinesterase,and reduce the impact on platelet level.It can also reduce the time of mechanical ventilation,shorten the length of stay in the icu,and reduce complications. |
PDF Full Text Request