Objective To investigate the protective effect of hemoperfusion combined with continuous renal replacement therapy in the treatment of heart and kidney injury in elderly patients with severe organophosphorus poisoning. Methods 120 patients with severe organophosphorus poisoning from September 2010 to June 2015 were randomly divided into the combination group and the control group,60 cases in each group. The control group was treated with routine gastric lavage,enema intestinal poison removal,atropine detoxi-fication,chlorine pralidoxime complex agent rehydration symptomatic treatment,and 12 h after admission,hemoperfusion was given once for 2-4 h. On this basis,the combination group was treated with continuous blood purification(CVVH)after 12 h,and the duration was 24-48 h. During each 12 h,the blood filtration treatment was given for a total of 3 times. Before treatment and at 3 d after treatment, the levels of IL-6 and TNF-α were detected by ELISA and the CRP level was detected by the immunoturbidimetry. The levels of SCr,Cys-C,CK-MB were detected by full automatic biochemical analyzer. The levels of cTnⅠand BNP were detected by immuno-chemical assay. The recovery time,acute physiology and chronic health status(APACHEmax Ⅱ),mechanical ventilation support time,me-chanical ventilation support time,pulmonary infection rate,and mortality in the two groups were observed and compared. Results After 3 d of treatment,the index levels in the combination group and the control group were as follows,IL-6 [(51. 49 ± 8. 53) ng/L vs (81. 06 ± 9. 62)ng/L,t=3. 084 ] ,CRP [(34. 81 ± 6. 05)mg/L vs(61. 85 ± 7. 38 )mg/L,t=3. 541 ] ,TNF-α [(46. 82 ± 7. 36)ng/L vs (68. 05 ± 9. 36)ng/L,t=2. 983 ] the levels in both groups decreased compared with before treatment,and the two groups also had sta-tistically significant difference( P < 0. 05);SCr [(123. 74 ± 22. 80) μmol/L vs (180. 63 ± 20. 62) μmol/L,t=2. 897 ] ,Cys-C [(1. 53 ± 0. 31) mg/L vs (2. 38 ± 0. 61) mg/L,t=3. 035 ] ,BNP [(490. 31 ± 62. 87) ng/mL vs (1 598. 46 ± 54. 29) ng/mL, t=3. 806 ] ,CK-MB [(42. 80 ± 5. 48)μg/L vs(60. 92 ± 8. 63)μg/L,t=3. 369 ] ,cTnⅠ[(0. 93 ± 0. 13)mg/L vs(1. 89 ± 0. 61)mg/L, t=3. 995 ] ,which were also significantly decreased compared with before treatment,and the two groups also had statistically significant difference ( P < 0. 05);the blood cholinesterase recovery time [(6. 69 ± 1. 04) d vs (8. 99 ± 1. 34) d,t=3. 095 ] ,APACHEmax Ⅱ[(24. 80 ± 5. 43) vs(30. 54 ± 6. 29),t=3. 905 ] ,mechanical ventilation time [(5. 94 ± 1. 36)d vs(9. 06 ± 1. 28)d,t=3. 319 ] ,the in-cidence of lung infection [(10/60,16. 67% ) vs (22/60,36. 67% ),χ2=3. 061 ] and mortality [(6/60,10. 00% ) vs (14/60, 23. 33%),χ2=2. 984 ] which were also significantly decreased compared with before treatment,and the two groups also had statistically significant difference( P < 0. 05). Conclusion Hemoperfusion combined with continuous renal replacement therapy can effectively re-move inflammatory mediators in the patients,and has protective effect on the heart and kidney injury of elderly patients with severe organophosphorus poisoning.%目的：探讨血液灌流联合持续性肾脏替代治疗对老年重度有机磷中毒患者心肾损伤的保护作用。方法选择2010年9月至2015年6月诊断为老年重度有机磷中毒患者120例，按随机数字表法分为联合组与对照组，各60例。对照组患者给予常规洗胃、灌肠清除肠道内毒物，给予阿托品解毒、氯解磷定复能剂补液对症处理，入院12 h内给予行血液灌流治疗1次，治疗2~4 h。联合组患者在对照组治疗基础上，12 h后给予持续性血液净化治疗（CVVH），持续24~48 h。期间每12小时给予血液滤过治疗1次，共3次。治疗前与治疗后第3天，采用酶联免疫吸附( ELISA )法检测血清白介细胞素－6（IL－6）、肿瘤坏死因子－α（TNF－α），采用免疫比浊法检测血清白蛋白（CRP）水平。采用全自动生化分析仪检测血肌酐（SCr）、胱抑素C（Cys－C）、血清肌酸激酶同工酶（CK－MB）水平，采用免疫化学发光法检测血清肌钙蛋白Ⅰ（cTnⅠ）、B型钠尿肽（BNP）水平。观察两组患者血胆碱酯酶活力恢复时间、急性生理学与慢性健康状况评分最大值（APACHEmaxⅡ）、机械通气支持时间、肺部感染发生情况及病死情况的差异。结果治疗后第3天，联合组与对照组比较，血清IL－6[（51.49±8.53）ng/L比（81.06±9.62）ng/L，t=3.084]、CRP [（34.81±6.05）mg/L比（61.85±7.38）mg/L，t=3.541]、TNF－α[（46.82±7.36）ng/L 比（68.05±9.36）ng/L，t=2.983]水平均较治疗前下降，且组间比较，差异有统计学意义（ P<0.05）。血 SCr [（123.74±22.80）μmol/L 比（180.63±20.62）μmol/L，t=2.897]、Cys－C [（1.53±0.31）mg/L 比（2.38±0.61）mg/L，t=3.035]、BNP [（490.31±62.87）ng/mL 比（1598.46±54.29）ng/mL，t=3.806]、CK－MB [（42.80±5.48）μg/L 比（60.92±8.63）μg/L， t=3.369]、cTnⅠ[（0.93±0.13）mg/L比（1.89±0.61）mg/L，t=3.995]水平也较治疗前明显下降，且组间比较，差异有统计学意义（ P<0.05）。联合组与对照组血胆碱酯酶活力恢复时间[（6.69±1.04）d比（8.99±1.34）d，t=3.095]、APACHEmaxⅡ[（24.80±5.43）比（30.54±6.29），t=3.905]、机械通气支持时间[（5.94±1.36）d比（9.06±1.28）d，t=3.319]、肺部感染发生率[（10/60，16.67%）比（22/60，36.67%），χ2=3.061]及病死率[（6/60，10.00%）比（14/60，23.33%），χ2=2.984]水平均较治疗前减少，且组间比较，差异有统计学意义（ P<0.05）。结论血液灌流联合持续性肾脏替代治疗可有效清除患者体内炎性介质，对老年重度有机磷中毒患者心肾损伤有保护作用。
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