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目的分析自拟大黄解毒汤联合血液灌流治疗急性有机磷农药中毒(AOPP)并发中毒性心肌炎患者的临床疗效。方法将2010年10月至2016年10月收治的AOPP并发中毒性心肌炎患者60例随机分为对照组和观察组,每组30例。2组均给予洗胃、利尿、维持水电解质平衡、吸氧等常规解毒及对症治疗,观察组在常规治疗基础上给予大黄解毒汤联合血液灌流治疗。比较2组阿托品用量、达到阿托品化的时间、心功能、心力衰竭程度、生存时间、并发症发生情况。采用丁酰硫代胆碱法测定2组胆碱酯酶活性。采用酶联免疫吸附实验(ELISA)测定2组血清白介素6(IL-6)、白介素8(IL-8)、白介素10(IL-10)、白介素1β(IL-1β)、肿瘤坏死因子α(TNF-α)水平。结果与对照组比较,观察组阿托品用量显著减少,达到阿托品化的时间显著缩短,心输出量(CO)、射血分数(EF)显著升高,心力衰竭程度显著改善,生存时间显著延长,并发症发生率显著降低(P<0.05)。与治疗前比较,2组治疗后胆碱酯酶活力均显著升高,IL-6、IL-8、IL-10、IL-1β、TNF-α均显著降低,但观察组改善程度优于对照组,差异有统计学意义(P<0.05)。结论自拟大黄解毒汤联合血液灌流能够明显提高AOPP并发中毒性心肌炎患者的治疗效果,降低并发症发生率,还能有效清除患者体内炎性因子。
Objective To analyze the clinical efficacy of combining rhubarb detoxification decoction with hemoperfusion in the treatment of acute organophosphorus pesticide poisoning (AOPP) complicated with toxic myocarditis. Methods Sixty patients with AOPP complicated with toxic myocarditis admitted from October 2010 to October 2016 were randomly divided into control group and observation group, 30 cases in each group. Both groups were given gastric lavage, diuresis, to maintain water and electrolyte balance, oxygen and other conventional detoxification and symptomatic treatment, the observation group on the basis of routine treatment given rhubarb detoxification combined with hemoperfusion treatment. The amount of atropine in two groups was compared, and the time of atropine, heart function, degree of heart failure, survival time and complications were compared. Group 2 cholinesterase activity was measured by butyrylthiocholine method. Serum levels of IL-6, IL-8, IL-10, IL-1β and TNF-α were measured by enzyme linked immunosorbent assay (ELISA) TNF-α) levels. Results Compared with the control group, the amount of atropine in the observation group was significantly reduced, the time to atropineization was significantly shortened, the cardiac output (CO) and ejection fraction (EF) were significantly increased, the degree of heart failure was significantly improved, the survival time was significantly prolonged, and the complications The incidence of disease was significantly lower (P <0.05). Compared with those before treatment, the activity of cholinesterase in both groups significantly increased after treatment, and the levels of IL-6, IL-8, IL-10, IL-1β and TNF- Group, the difference was statistically significant (P <0.05). Conclusions Self-made rhubarb detoxification combined with hemoperfusion can significantly improve the therapeutic effect of AOPP in patients with toxic myocarditis, reduce the incidence of complications, but also effectively clear the inflammatory cytokines in patients.