Objective:To investigate the effects of sequential blood purification and hemoperfusion on myocardial injury and the serum levels of neuron-specific enolase (NSE) and cholinesterase (CHE) in patients with acute organophosphorus poisoning (AOPP).Methods:80 AOPP patients admitted in our hospital from January 2012 to January 2015 were selected and randomly divided into an experimental group and a control group,with 40 cases in each group.Patients in the experimental group received sequential blood purification therapy,while those in the control group were treated with hemoperfusion only.The therapeu tic efficacy,and the levels of troponin (cTnI),NSE and CHE in serum were observed and compared.Results:The total response rate in the experimental group was significantly higher than that in the control group (97.5％ vs.75.0％,P＜0.05).After treatment,the cTnI level was significantly elevated,and then fell to the normal range in both groups.The serum level of cTnI in the experimental group was significantly lower than that in the control group at every time points (P＜0.05).The level of NSE was lower,while the CHE level was higher in the experimental group than those in the control group on 1 and 2 days after treatment (P＜0.05).No significant difference was noted in the NSE and CHE levels on days 3 posttreatment.Conclusion:Sequential blood purification was more effective than hemoperfusion for AOPP treatment.It could relieve myocardial injury,decrease the serum level of NSE,and increase CHE level.%目的:探讨序贯血液净化与单独血液灌流治疗急性有机磷中毒(AOPP)的疗效差异及对心肌损伤、血清神经元特异性烯醇化酶(NSE)和胆碱酯酶(CHE)水平的影响.方法:选取2012年1月至2015年1月南京医科大学附属淮安第一医院收治的80例AOPP患者,按随机数字表法分为观察组和对照组,每组40例.对照组采用单独血液灌流治疗,观察组采用序贯血液净化治疗.比较两组临床疗效,观察患者治疗前及治疗后1d、2d、3d肌钙蛋白(cTnI)、血清NSE、CHE水平变化情况.结果:观察组治疗总有效率显著高于对照组(P＜o.05);两组治疗后血清cTnI水平先升高后回落、稳定在正常范围内,观察组治疗后各时间点血清cTnI水平显著低于对照组(均P＜0.05);治疗后1d和治疗后2d,观察组患者血清NSE水平显著低于对照组(均P＜0.05),CHE水平显著高于对照组(均P＜0.05),而治疗后3d两组患者NSE、CHE水平比较差异无统计学意义(均P＞0.05).结论:序贯血液净化治疗AOPP的疗效优于单独血液灌流,能有效减轻心肌损伤,降低血清NSE水平,增加CHE水平,值得临床推广应用.
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