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目的探讨生脉注射液辅助治疗重度急性有机磷农药中毒(acute organophosphorus pesticide poisoning,AOPP)的临床效果。方法 2011年6月—2012年12月收治的重度AOPP患者103例,随机分为治疗组53例和对照组50例。两组均彻底清除毒物,包括洗胃、清洗皮肤等,静脉注射阿托品、胆碱酯酶(cholinesterase,ChE)复能剂等,呼吸机辅助呼吸、血液灌流等。治疗组在上述治疗基础上入院后即给予生脉注射液60 ml加入5%葡萄糖注射液250或500 ml静脉滴注,1次/d。两组均治疗7~10 d对比阿托品使用情况及住院时间,治疗第3、7天抽取静脉血化验CK-MB、LDH、AST和ChE活力,心电监护并每天行心电图检查,比较痊愈情况。计量资料采用t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果治疗组阿托品化时阿托品用量、阿托品总量、住院时间[(50±18)、(853±39)mg、(12.3±2.1)d]与对照组[(87±25)、(1 067±43)mg、(15.8±2.4)d]比较差异均有统计学意义(均P<0.05)。CK-MB、LDH、AST治疗组治疗第3天分别为(68.2±15.3)、(214±25)、(265±26)U/L,治疗第7天分别为(35.1±12.2)、(96±21)、(84±24)U/L;对照组治疗第3天分别为(95.3±16.1)、(322±26)、(351±28)U/L,治疗第7天分别为(79.3±15.6)、(157±22)、(176±27)U/L,两组比较差异均有统计学意义(均P<0.05)。心电图异常率、痊愈率治疗组分别为13.2%、94.3%,对照组分别为42.0%、80.0%,两组比较差异均有统计学意义(均P<0.05)。结论在常规治疗的基础上应用生脉注射液治疗重度AOPP,可降低心肌损伤程度,临床效果满意。
Objective To investigate the clinical effect of Shengmai injection in the treatment of severe acute organophosphorus pesticide poisoning (AOPP). Methods 103 patients with severe AOPP admitted from June 2011 to December 2012 were randomly divided into treatment group (n = 53) and control group (n = 50). The two groups were completely cleared of poisons, including gastric lavage, skin washing, intravenous atropine, cholinesterase (ChE) and other energy agents, ventilator-assisted breathing, blood perfusion. The treatment group was given on the basis of the above treatment Shengmai injection 60 ml added 5% glucose injection 250 or 500 ml intravenous infusion, 1 time / d. Both groups were treated 7 ~ 10 d atropine use and hospitalization time, the first 3,7 days after treatment venous blood samples taken CK-MB, LDH, AST and ChE activity, ECG monitoring and daily electrocardiogram to compare the recovery. Measurement data using t test, count data using χ2 test, P <0.05 for the difference was statistically significant. Results The total amount of atropine, the total amount of atropine and hospital stay in the treatment group were significantly lower than those in the control group [(50 ± 18), (853 ± 39) mg, (12.3 ± 2.1) d] [(87 ± 25) 43) mg, (15.8 ± 2.4) d], respectively (all P <0.05). The levels of CK-MB, LDH and AST in the treatment group were (68.2 ± 15.3), (214 ± 25) and (265 ± 26) U / L respectively on the third day after treatment and were (35.1 ± 12.2) and (95 ± 16.1), (322 ± 26) and (351 ± 28) U / L respectively on the third day after treatment in the control group and (79.3 ± 28) U / ± 15.6), (157 ± 22) and (176 ± 27) U / L, respectively. There was significant difference between the two groups (all P <0.05). The rates of abnormal ECG and cure were 13.2% and 94.3% in the treatment group and 42.0% and 80.0% in the control group respectively (all P <0.05). Conclusion Shengmai injection on the basis of conventional treatment of severe AOPP can reduce the degree of myocardial injury, the clinical effect is satisfactory.