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目的:比较改良型鼻肠管和鼻胃管联用于血液净化对预防和治疗重症有机磷农药中毒患者诱导迟发性多发神经病的疗效。方法:选取2014年6月—2015年10月间收治的急性重度有机磷中毒(ASOP)患者80例,将其随机分为观察组和对照组,每组40例;两组患者均给予自动洗胃机清水洗胃、快速建立静脉通道,以及给予硫酸阿托品注射液、氯解磷定注射液及对症支持治疗;对照组患者则在此基础上给予单纯洗胃等治疗以及给予硫酸阿托品注射液、氯解磷定注射液及对症支持治疗;观察组患者均给予自动洗胃机清水洗胃、快速建立静脉通道,以及给予硫酸阿托品注射液、氯解磷定注射液及对症支持治疗,同时置入鼻肠管和鼻胃管洗胃等治疗,比较两组患者洗胃等治疗后昏迷复醒时间、机械通气时间、胆碱酯酶(ChE)活性复常时间、住院时间和药物用量,以及迟发性多发神经病的发生情况等。结果:观察组患者治疗后昏迷复醒时间、机械通气时间、胆碱酯酶(ChE)活性复常时间、住院时间均短于对照组(P<0.05),中间综合征的发生率和病死率低于对照组(P<0.05);阿托品、氯解磷定用量小于对照组(P<0.05),提示观察组患者治疗效果优于对照组(P<0.05);随访患者结果发现,观察组患者迟发性神经病的发生率低于对照组(P<0.05),运动传导速度(MCV)、感觉传导速度(SCV)优于对照组(P<0.05),提示改良型鼻肠管和鼻胃管联用于血液净化可有效预防重症有机磷农药中毒患者诱导迟发性多发神经病的发生,并有益于患者运动功能的恢复。结论:改良型鼻肠管和鼻胃管联用于血液净化可有效预防和治疗重症有机磷农药中毒患者诱导迟发性多发神经病的发生,可改善患者预后的康复。
Objective: To compare the efficacy of modified nasal tube and nasogastric tube in blood purification in the prevention and treatment of patients with severe organophosphorus pesticide poisoning induced delayed polyneuropathy. Methods: Eighty patients with acute severe organophosphorus poisoning (ASOP) who were admitted from June 2014 to October 2015 were randomly divided into observation group and control group, 40 cases in each group. Both groups were given automatic washing Gastric gastric lavage, rapid establishment of intravenous access, and given atropine sulfate injection, chlorpromazine given injection and symptomatic supportive treatment; the control group patients are given on this basis, such as simple gastric lavage treatment and given atropine sulfate injection, Chlorpromazine given injection and symptomatic supportive treatment; patients in the observation group were given gastric lavage with gastric lavage, rapid establishment of intravenous access, and given atropine sulfate injection, chlorpromazine given injection and symptomatic supportive treatment, while placing Nasal tube and nasogastric tube gastric lavage treatment. The coma recovery time, mechanical ventilation time, cholinesterase (ChE) activity recovery time, hospitalization time and drug dosage were compared between the two groups after gastric lavage. The incidence of polyneuropathy and so on. Results: The coma recovery time, mechanical ventilation time, cholinesterase (ChE) activity recovery time and hospital stay in the observation group were shorter than those in the control group (P <0.05), the incidence of intermediate syndrome and mortality (P <0.05). The dosage of atropine and chlorophenol was lower than that of the control group (P <0.05), which indicated that the treatment effect of the observation group was better than that of the control group (P <0.05). The follow-up results showed that the patients in the observation group The incidence of delayed neuropathy was lower than that of the control group (P <0.05), motor conduction velocity (MCV) and sensory conduction velocity (SCV) were superior to the control group (P <0.05), suggesting that modified nasal and nasogastric tube For blood purification can effectively prevent severe organophosphorus pesticide poisoning induced delayed polyneuropathy and beneficial to patients with motor function recovery. Conclusion: The combination of modified nasal tube and nasogastric tube for blood purification can effectively prevent and treat severe organophosphorus pesticide poisoning induced delayed polyneuropathy, which can improve the prognosis of patients.