有机磷中毒患者血胆碱酯酶活性的变化规律及临床意义

有机磷中毒患者血胆碱酯酶活性的变化规律及临床意义

【摘要】目的研究急性有机磷中毒(AOPP)患者全血及血清胆碱脂酶(ChE)活性的变化规律。方法所有51例患者入院后均给予清除毒物、应用双复磷或氯磷定、阿托品及积极的对症支持治疗。分别于治疗前、治疗后6~12、24、48、72、96、120 h及出院时抽末梢血测定全血及血清ChE活性,并于同期测定37名均为健康者血ChE活性作为正常对照。结果全血、血清ChE活性在中毒患者治疗前均较正常对照组明显降低(P＜0.01),治疗后轻度患者的全血ChE活性恢复较快,至出院时基本恢复正常;中、重度患者的全血ChE活性于治疗后24 h降至最低,于48 h缓慢回升,至出院时仍未恢复至正常水平;3例死亡患者全血ChE活性持续不回升。血清ChE活性值波动较大,分布较离散,恢复相对较快。结论全血ChE 活性是对急情有机磷中毒进行早期诊断,判断疗效和估计预后的重要指标,在治疗上具有重要的指导意义。

【Abstract】Objective TO investigate the changing regularity and significance of cholinesterase activity of complete blood and serum in patients with acute organophosphate poisoning(AOPP).Methods All of the fifty-one cases of AOPP were given cleaning poison,administrating ujophosan or protopam chloride,atropine and acitively assistant treatment.They were respectively detected the cholinesterase activity of complete blood and serum from peripheral venous blood before therapy and at the time of 6-12,24,48,72,96,120 h after therapy and discharge.And at the same time thirty-seven cases of healthy people were done the same thing to act as normal control group.Results The cholinesterase activity of complete blood and serum in mild,moderate and severe group were significantly decreased as compared with that of normal control group before therapy(P＜0.01).The cholinesterase activity of complete blood in mild group recovered quicklier than that of moderate and severe group after therapy and was about normal when discharged.The cholinesterase actvity of complete blood in moderate and severe group decreased to the lowest level at the time of 24 h and began to increase at the time of 48 h after therapy.But it was abnormal until discharge.The cholinesterase activity of complete blood of three cases of death always did not recover.The cholinesterase activity of serum fluctuated greatly,distributed extensively and recovered quickly.Conclusion The cholinesterase activity of complete blood is a very important marker for early diagnosis,judging effect and prognosis.It has the directive value in therapy.

【Key words】Cholinesterase; Activity ; AOPP

急性有机磷中毒(AOPP)是内科常见的急症之一,本研究总结了我院1997年10月至2008年4月间收治的AOPP患者共51例,全部应用改良的EIIman法[1]测定患者全血及血清胆碱酯酶(ChE)活性,现报告如下。

1 材料与方法

1.1 研究对象AOPP患者共51例,男16例,女35例,年龄8~75岁,其中敌敌畏中毒患者24例,对硫磷中毒者11例,甲拌磷中毒者6例,稻瘟净中毒者3例,内吸磷中毒者2例,甲胺磷中毒者2例,辛硫磷中毒者1例,水胺硫磷中毒者1例,乐果中毒者1例,均为口服中毒,服毒量为20~350 ml,中毒至就诊时间为20~180 min。参照《职业性急性有机磷农药中毒的诊断及处理原则》[2]进行诊断和病情分级,51例患者中轻度中毒8例,中度中毒12例,重度中毒31例,各组间年龄、性别差异均无显著性(P＞0.05),全部患者均无心、肺、肝、肾、脑病,无高血压、糖尿病、贫血、营养不良、甲状腺功能亢进、及结缔组织病。

1.2 正常对照组共37例,男15例,女22例,年龄9~74岁,均为经体检健康者。

1.3 方法研究对象均于入院时立即采末梢血,之后给予常规治疗(包括清除毒物、应用双复磷或氯磷定、阿托品及积极的对症支持治疗),再于治疗后6~12、24、48、72、96、120 h及出院时采末梢血(轻度患者96 h与出院时相同),由本院检验科采用改良的EIIman法,用721型分光光度计测定ChE活性。37例健康人同期采集末梢血测定ChE活性。

1.4 统计学处理实验数据采用x±s表示,以t检验作数据间的统计处理。

2 结果

48例存活患者全血及血清ChE活性测定结果见表1。轻、中、重中毒患者全血ChE活性在治疗前均较对照组均明显降低(P＜0.01);各治疗组在治疗后72 h ChE活性在治疗前有显著性差异(P＜0.01或P＜0.05);中、重度患者在入院时ChE 活性已经明显下降,分别于治疗后24 h显著降低,至48 h则开始缓慢回升,但出院时仍未恢复正常水平(P＜0.01);血清ChE活性波动较大,且较离散,恢复相对较快。