Efficacy of bedside hemoperfusion in emergency department for sedative and hypnotic drug poisoning in the elderly
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摘要: 目的:探究急诊床旁血液灌流治疗老年镇静催眠类药物中毒患者的临床效果。方法:选取2017年1月—2020年4月期间我院112例老年镇静催眠类药物中毒患者的临床资料进行回顾性分析,根据治疗方案不同分为研究组与对照组,各56例。两组入院后均给予基础干预,于此基础上,对照组采取盐酸纳洛酮及清开灵注射液治疗,研究组在对照组基础上加用急诊床旁血液灌流。比较两组治疗效果、并发症发生率、意识清醒时间及住院时间、治疗前后血浆药物浓度、血气状态指标[动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、平均动脉压(MAP)、pH值]、炎性因子(IL-6、IL-8、TNF-α)水平。结果:研究组总有效率(92.86%)高于对照组(78.57%),差异有统计学意义(P<0.05);研究组意识清醒时间及住院时间短于对照组(P<0.05);研究组治疗后15、30、60、120、720 min时血浆药物浓度低于对照组(P<0.05);研究组治疗后PaO2、MAP高于对照组,PaCO2、pH值低于对照组(P<0.05);研究组治疗后血清IL-6、IL-8、TNF-α水平低于对照组(P<0.05);研究组并发症发生率(3.57%)低于对照组(14.29%),差异有统计学意义(P<0.05)。结论:急诊床旁血液灌流配合常规药物治疗能进一步降低老年镇静催眠类药物中毒患者血浆药物浓度,有效改善血气状态,降低血清炎性因子水平,促进患者恢复,疗效显著,安全性高。Abstract: Objective: To explore the clinical effect of emergency bedside hemoperfusion in the treatment of elderly patients with sedative and hypnotic drug poisoning.Methods: The clinical data of 112 elderly patients with sedative and hypnotic drug poisoning in our hospital from January 2017 to April 2020 were selected for retrospective analysis. According to different treatment plans, they were divided into study group and control group. 56 cases were in each group. Both groups were given basic intervention after admission. On this basis, the control group was treated with naloxone hydrochloride and Qingkailing injection, and the study group was given perfusion of emergency bedside blood on the basis of the control group. The treatment effect, incidence of complications, time of consciousness and hospitalization, plasma drug concentration and blood gas state indicators[arterial blood oxygen partial pressure(PaO2), arterial blood carbon dioxide partial pressure(PaCO2), mean arterial pressure(MAP), pH value], and inflammatory factor levels(IL-6, IL-8, TNF-α)]before and after treatment were compared between the two groups.Results: The total effective rate in the study group(92.86%) was higher than that in the control group(78.57%)(P<0.05); the time for consciousness and hospitalization in the study group was shorter than that in the control group(P<0.05); the plasma drug concentration in the study group was lower than that in the control group at 15 min, 30 min, 60 min, 120 min, and 720 min(P<0.05); PaO2 and MAP in the study group were higher than those in the control group after treatment, and the values of PaCO2 and pH were lower than the control group(P<0.05); the levels of serum IL-6, IL-8, and TNF-α in the study group were lower than those in the control group(P<0.05); the incidence of complications in the study group(3.57%) was lower than that in the control group(14.29%)(P<0.05).Conclusion: Emergency bedside blood perfusion combined with conventional drug treatment can further reduce the plasma drug concentration in elderly patients with sedative hypnotic poisoning and effectively improve the blood gas state, reduce the level of serum inflammatory factors, and promote the recovery of patients. It has obvious curative effect and high safety.
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[1] Tseng HY,Yu SH,Lee CY,et al.Sedative-hypnotic drug use among community-dwelling elderly in Taiwan[J].Int Psychogeriatr,2018,30(7):957-965.
[2] Jiang M,Wang J,Gu SS.Clinical features and prognosis analysis of the elderly and youth patients with acute severe poisoning[J].Chin Critical Care Med,2018,30(8):790-794.
[3] 郑燕清,陈建霞,庄海阳,等.纳洛酮与纳美芬治疗急性酒精中毒的效果对比[J].西南国防医药,2018,28(7):653-655.
[4] 李建武,曹静.纳美芬治疗急性重度酒精中毒疗效分析[J].山西医药杂志,2019,48(18):2251-2253.
[5] 王海荣.清开灵注射液辅助治疗在重度安眠药中毒患者抢救中的应用效果[J].临床医学研究与实践,2019,4(4):125-127.
[6] 刘传令.评价血液灌流法在急性重症安眠药中毒急诊治疗中的效果[J].中国实用医药,2018,13(15):32-34.
[7] 李明,肖广辉,阎旸.纳洛酮、醒脑静联合治疗老年急性安眠药中毒的疗效及对生活功能的影响[J].中国老年学杂志,2017,37(12):3050-3051.
[8] 韩占升.血液灌流联合盐酸纳美芬救治重度安眠药中毒的疗效观察[J].医学理论与实践,2017,30(7):1021-1022.
[9] Geulayov G,Ferrey A,Casey D,et al.Relative toxicity of benzodiazepines and hypnotics commonly used for self-poisoning:An epidemiological study of fatal toxicity and case fatality[J].J Psychopharmacol,2018,32(6):654-662.
[10] 林华君,张敏.急性重症安眠药中毒的急诊治疗方法和效果探讨[J].国际医药卫生导报,2019,25(19):3290-3291.
[11] 张诗锐.盐酸纳洛酮注射液联合脑苷肌肽注射液治疗急性重度酒精中毒的临床疗效分析[J].中国现代药物应用,2019,13(10):137-138.
[12] 毛晓春,袁军,马忠杰.纳美芬联合清开灵注射液在重度安眠药中毒抢救中的效果观察[J].贵州医药,2018,42(2):204-205.
[13] 李忠平,范青香,李晋霞,等.血液灌流救治急危重症有机磷中毒患者的疗效观察[J].中国中西医结合急救杂志,2019,26(1):117-119.
[14] Yen TH,Wang IK,Hsu CW.Hemoperfusion for paraquat poisoning[J].Kidney Int,2018,94(6):1239.
[15] Pomarè Montin D,Ankawi G,Lorenzin A,et al.Biocompatibility and Cytotoxic Evaluation of New Sorbent Cartridges for Blood Hemoperfusion[J].Blood Purif,2018,46(3):187-195.
[16] 李霁,张剑锋,卢俊宇,等.卡托普利灌胃后百草枯中毒急性肾损伤大鼠肾组织病理、TNF-α和NF-κB表达及血清IL-6水平变化[J].山东医药,2018,58(47):47-51.
[17] Xu JJ,Zhen JT,Tang L,et al.Intravenous injection of Xuebijing attenuates acute kidney injury in rats with paraquat intoxication[J].World J Emerg Med,2017,8(1):61-64.
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