内科

目的探讨20.0%脂肪乳辅助治疗重度急性有机磷中毒(AOPP)伴心肌损伤患者的临床效果及对患者心肌酶、心功能、血清炎症因子水平的影响。方法选取2018年7月至2020年12月我科收治的重度AOPP伴心肌损伤患者93例作为研究对象，采用掷币法分为对照组（46例）和观察组（47例）。对照组患者给予常规治疗，观察组患者在对照组的基础上给予20.0%脂肪乳辅助治疗，疗程7 d。比较两组患者的临床疗效以及心肌酶、心功能、血清炎症因子水平。结果治疗7 d后，观察组患者的治疗总有效率（91.5%）显著高于对照组（73.9%），差异有统计学意义（P＜0.05）。治疗前，两组患者的肌酸激酶同工酶MB（CK-MB）、肌酸激酶（CK）、肌红蛋白（MYO）、肌钙蛋白（cTnI）水平比较，差异无统计学意义（P＞0.05）；治疗7 d后，两组患者的CK-MB、CK、MYO、cTnI 水平均显著降低，观察组患者的水平显著低于对照组，差异有统计学意义（P＜0.05）。治疗前，两组患者的左室收缩末期内径（LVESD）、左室射血分数（LVEF）比较，差异无统计学意义（P＞0.05）。治疗7 d后，两组患者的LVESD均明显缩短，LVEF均明显升高；观察组患者的LVESD显著短于对照组，LVEF显著高于对照组，差异有统计学意义（P＜0.05）。治疗前，两组患者的血清C反应蛋白（CRP）、肿瘤坏死因子α（TNF-α）、白细胞介素6（IL-6）水平比较，差异无统计学意义（P＞0.05）；治疗7 d后，两组患者的CRP、TNF-α、IL-6水平均显著降低，观察组患者的水平显著低于对照组，差异有统计学意义（P＜0.05）。结论20.0%脂肪乳辅助治疗重度急性有机磷中毒伴心肌损伤患者的临床效果显著，可以显著降低患者的血清心肌酶及炎症因子水平，提高患者的心功能，促进患者康复。

ObjectiveTo investigate the clinical effect of 20.0% fat emulsion in the adjuvant treatment of patients with severe and acute organophosphate poisoning (AOPP) complicated with myocardial injury and its influence on myocardial enzymes, cardiac function, and serum inflammatory factors level. MethodsNinety-three patients with severe AOPP complicated with myocardial injury admitted to our department from July 2018 to December 2020 were selected as the research objects, and they were divided into control group (46 cases) and observation group (47 cases) by the coin tossing method. The patients in the control group were given conventional treatment, based on which the patients in the observation group were given 20.0% fat emulsion as assisted treatment, for a 7-day treatment course. The clinical efficacy and myocardial enzymes, cardiac function and serum inflammatory factors levels were compared between the two groups. ResultsAfter 7 days of treatment, the total effective rate of the observation group (91.5%) was significantly higher than that of the control group (73.9%), with a statistically significant difference (P＜0.05). Before treatment, there were no statistically significant differences in the levels of creatine kinase isoenzyme MB (CK-MB), creatine kinase (CK), myoglobin (MYO) and cardiac troponin (cTnI) between the two groups (P＞0.05). After 7 days of treatment, the levels of CK-MB, CK, MYO and cTnI in the two groups decreased significantly, and the levels in the observation group were significantly lower than those in the control group, with statistically significant differences (P＜0.05). Before treatment, there were no statistically significant differences in left ventricular end systolic diameter (LVESD) and left ventricular ejection fraction (LVEF) between the two groups (P＞0.05). After 7 days of treatment, LVESD significantly shortened in both groups, whereas LVEF increased prominently, and the observation group yielded a shorter LVESD, but a higher LVEF as compared with the control group, with statistically significant differences (P＜0.05). Before treatment, the levels of serum C-reactive protein (CRP), tumor necrosis factor α（TNF-α）and interleukin-6 (IL-6) had no statistically significant differences between the two groups (P＞0.05). After 7 days of treatment, the levels mentioned above significantly decreased in both groups, and the observation group yielded lower levels in comparison with the control group, with statistically significant differences (P＜0.05). ConclusionEmploying 20.0% fat emulsion in the adjuvant treatment of patients with severe AOPP complicated with myocardial injury has prominently clinical effect, which can significantly decrease the levels of serum myocardial enzymes and inflammatory factors, and improve the heart function.