目的：探讨血液灌流联合血浆置换对老年有机磷中毒伴中间期肌无力综合征的临床疗效。方法选取该院2011年10月至2013年12月诊治的老年有机磷中毒伴中间期肌无力综合征患者46例，采用随机数字表法分为两组，其中23例患者实施血液灌流治疗为对照组，23例患者实施血液灌流联合血浆置换治疗为观察组，比较两组患者生化指标、心肌酶指标、疗效及并发症情况。结果治疗后两组患者的 B 型钠尿肽（ BNP）、C反应蛋白（ CRP）、肿瘤坏死因子（ TNF）α、肌酸激酶（ CK）、肌酸激酶同工酶（ CK－MB）、天门冬氨酸氨基转移酶（ ALT）、乳酸脱氢酶（ LDH）均显著降低，而胆碱酯酶（ChE）均显著升高。观察组患者BNP、CRP、TNF－α、CK、CK－MB、ALT、LDH、反跳发生率、死亡率、并发症发生率均明显低于对照组者ChE、治疗有效率均明显高于对照组，观察组患者昏迷时间、ChE 恢复时间、住院时间、阿托品用量、氯解磷定用量均明显少于对照组（ P＜0．05）。结论血液灌流联合血浆置换是治疗老年有机磷中毒伴中间期肌无力综合征的有效方法，可明显改善患者的临床指标，显著缩短患者的治疗时间，临床疗效显著且安全性高，值得临床推广。%Objective To investigate the clinical effect of hemoperfusion combined with plasma exchange in treatment of elderly pa-tientswithorganicphosphoruspoisoningandintermediatemyastheniasyndrome.Methods 46elderlypatientswithorganicphosphoruspoi-soning and intermediate myasthenia syndrome were selected and randomly divided into two groups.The changes of biochemical indexes, the levels of myocardial enzymes and complications were compared between two groups.Results After treatment, the levels of BNP, CRP, TNF-α, CK, CK-MB, AST, LDH were decreased significantly while h-CHE was increased significantly in two groups.The mortality rate and the incidence of complication in observation group were significantly lower than those of control group.The level of h-CHE in observation group was significantly higher than that of control group.The cholinesterase recovery time, hospitalization time, dosages of atropine and pra-lidoxime chloride in observation group were significantly less than those of control group (P<0.05).Conclusions Hemoperfusion and plas-ma exchange are effective methods in treatment of elderly patients with organic phosphorus poisoning and intermediate myasthenia syndrome, which could significantly improve clinical indexes and shorten treatment time.
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