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阿托品联合纳洛酮治疗有机磷中毒呼吸衰竭患者疗效及对肾功能、血清学指标的影响

作者:杨 静1 王彦霞2

所属单位:1.漯河医学高等专科学校第二附属医院急诊科 (河南 漯河 462300)2.漯河医学高等专科学校第二附属医院心内科 (河南 漯河 462300)

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摘要

目的 探讨阿托品联合纳洛酮治疗有机磷中毒呼吸衰竭患者疗效及对肾功能、血清学指标的影响。方法 选择医院 2015年2月-2018年2月收治的有机磷中毒呼吸衰竭患者80例,按照随机数表法分为观察组和对照组,各40例,两组 均接受有机磷中毒呼吸衰竭的常规治疗,对照组加用阿托品常规治疗方法,观察组加用阿托品联合纳洛酮治疗,两 组均持续用药7d。对比两组治疗前后的肾功能、血清学指标及疗效。结果 治疗后观察组患者的阿托品化时间、住 院时间均短于对照组(P<0.05),观察组患者的阿托品化用量、尿蛋白定量、尿素氮、肌酐、D-Dimer、BNP及死亡 率均显著低于对照组(P<0.05),观察组患者的FT3水平及治愈率明显高于对照组(P<0.05)。结论 阿托品联合纳洛 酮治疗有机磷中毒呼吸衰竭疗效显著,且具有降低血清学指标,保护肾功能的作用。

Objective To explore the efficacy of atropine combined with naloxone in the treatment of patients with respiratory failure caused by organophosphate poisoning and its effects on renal function and serological markers. Methods 80 patients with respiratory failure caused by organophosphate poisoning who were admitted to the hospital from February 2015 to February 2018 were selected and divided into observation group and control group according to the random number table method, with 40 cases in each group. The two groups were given conventional treatment of respiratory failure caused by organophosphate poisoning, and control group was given atropine conventional treatment, and observation group was given atropine combined with naloxone, and the two groups were continuously treated for 7d. The renal function, serological markers and efficacy were compared between the two groups before and after treatment. Results After treatment, the atropinization time and hospital stay in observation group were shorter than those in control group (P<0.05), and the atropinization dosage, urine protein quantitation, urea nitrogen, creatinine, D-Dimer, BNP and mortality rate in observation group were significantly lower than those in control group (P<0.05), and the FT3 level and cure rate in observation group were significantly higher than those in control group (P<0.05). Conclusion Atropine combined with naloxone has significant efficacy in the treatment of respiratory failure caused by organophosphate poisoning, and it has effects of lowering serological markers and protecting renal function.

【关键词】阿托品;纳洛酮;有机磷中毒;呼吸衰竭;肾功能;血清学指标

【中图分类号】R563.8

【文献标识码】A

【DOI】10.3969/j.issn.1009-3257.2019.02.019

前言

有机磷中毒起病急病情发展快,可产生毒蕈碱 样、烟碱样及中枢神经系统症状,严重者可出现脑 水肿、肺水肿及休克等并发症,甚至死亡。阿托品 是目前最常用的抗胆碱药,但传统治疗方式使用剂量 较大,易导致阿托品中毒,剂量不足时又容易引起反 跳现象的发生[1]。近年来,纳洛酮由于可快速解除中 枢抑制,清除自由基而被广泛应用于治疗中枢神经病理反应性疾病,可快速缓解病情,保护脑组织。本研 究通过采用阿托品联合纳洛酮治疗有机磷中毒呼吸衰 竭,为临床治疗有机磷中毒呼吸衰竭及其机制提供依 据。现报道如下。