【摘要】 目的：观察血液滤过联合血液灌流治疗急性重度有机磷农药中毒患者的效果。方法：选取 2020 年 2 月至 2021 年 2 月该院收治的 60 例急性重度有机磷农药中毒患者进行前瞻性研究，按照随机数字表法分为对照组和观察组各 30 例。对照组给予血液灌流治疗，观察组在对照组治疗基础上联合血液滤过治疗，比较两组临床疗效，治疗前后肝功能指标 [ 总胆红素（TBIL）、碱性磷酸酶（ALP）、血清淀粉酶（AMS）、天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）] 水平、炎性因子 [ 超敏 C 反应蛋白（hs-CRP）、白细胞介素 -8（IL-8）、血清转化生长因子 -β₁（TGF-β₁）] 水平、预后恢复情况及不良反应发生率。结果：观察组治疗总有效率为 90.00%，高于对照组的 66.67%，差异有统计学意义（P<0.05）；治疗后，观察组 TBIL、ALP、AMS、AST 及 ALT 水平均低于对照组，差异有统计学意义（P<0.05）；观察组 hs-CRP、IL-8、TGF-β₁水平均低于对照组，差异有统计学意义（P<0.05）；观察组乙酰胆碱酯酶恢复 70%的时间、住 ICU 时间、住院时间、撤机时间、昏迷时间等均短于对照组，差异有统计学意义（P<0.05）；两组不良反应发生率比较，差异无统计学意义（P>0.05）。结论：血液滤过联合血液灌流治疗急性重度有机磷农药中毒患者，可提高临床疗效，减轻器官功能损伤，降低机体炎性因子水平，缩短预后恢复时间，其效果优于单纯血液灌流治疗。更多还原

【Abstract】 Objective: To observe effects of hemofiltration combined with hemoperfusion in treatment of patients with acute severe organophosphorus pesticide poisoning. Methods: 60 patients with acute severe organophosphorus pesticide poisoning admitted to our hospital from February 2020 to February 2021 were selected for the prospective study, and were divided into control group and observation group according to the random number table method, 30 cases in each group. The control group was given hemoperfusion therapy, while the observation group was combined with hemofiltration therapy on the basis of that of the control group. The clinical efficacy, the levels of liver function indexes before and after the treatment [total bilirubin （TBiL）, alkaline phosphatase （ALP）, serum amylase （AMS）, glutamate aminotransferase （AST）, alanine aminotransferase （ALT）], the inflammatory factor levels [high-sensitivity C-reactive protein （hs-CRP）, interleukin-8 （IL-8）, serum transforming growth factor-β₁ （TGF-β₁）], the prognosis recovery situations, and incidence of adverse reactions were compared between the two groups. Results:The total effective rate of the observation group was 90.00%, which was higher than 66.67% of the control group, and the difference was statistically significant （P<0.05）. After the treatment, the levels of TBiL, ALP, AMS, AST and ALT in the observation group were lower than those in the control group, and the differences were statistically significant （P<0.05）. The levels of hs-CRP, IL-8 and TGF-β₁ in the observation group were lower than those in the control group, and the differences were statistically significant （P<0.05）. The time of 70% recovery of acetylcholinesterase, the ICU stay time, the hospitalization time, the off-ventilator time and the coma time in the observation group were all shorter than those in the control group, and the differences were statistically significant （P<0.05）. However, there was no significant difference in the incidence of adverse reactions between the two groups （P>0.05）. Conclusions: Hemofiltration combined with hemoperfusion in the treatment of the patients with acute severe organophosphorus pesticide poisoning can improve the clinical efficacy, reduce the organ function damage, reduce the body’s inflammatory reactions, and shorten the prognosis recovery time. Moreover, it is superior to single hemoperfusion therapy.更多还原