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目的:探讨急性重度敌敌畏中毒患者血清儿茶酚胺水平与其心脏损伤的关系。方法:选取我院2009年12月至2011年12月收治的急性重度敌敌畏中毒患者40例,接受阿托品和氯解磷定等常规治疗,检测患者入院第1、3、5天血清肌酸激酶(CK-MB)、心肌肌钙蛋(CTNI)、胆碱酯酶(AchE)、乙酰胆碱(Ach)、肾上腺素(EPI)和去甲肾上腺素(NorP)等指标,分析患者血清儿茶酚胺水平与其心脏损伤的关系。结果:40例患者中,34例存活,6例死亡;窦性心动过速35例,心电图(ECG)ST-T改变36例;血清CK-MB、CTNI入院第1、3、5天相比,先升高后降低,出院时降至正常,变化差异有统计学意义(CK-MB:H=8.782,P=0.002;CTNI:H=5.017,P=0.024)。Ach入院第1天时最高,逐渐降低,出院时恢复到正常水平,变化差异有统计学意义(H=9.235,P=0.002;AchE入院第1天时最低,逐渐升高至正常,变化差异有统计学意义(H=46.891,P=0.001)。肾上腺素(EPI)和去甲肾上腺素(NorP)代表儿茶酚胺的变化,入院当天为峰值,其后均逐渐下降,出院恢复正常,变化差异有统计学意义(EPI:H=16.031,P=0.021;NorP:H=57.913,P=0.025)。进一步分析显示EPI和与NorP水平分别与CK-MB和CTNII呈显著正相关,差异均具有统计学意义(P<0.05)。结论:敌敌畏中毒时,儿茶酚胺与乙酰胆碱的释放增多,可能引起心肌损害或加重心肌缺血的严重程度。
Objective: To investigate the relationship between serum catecholamine levels and cardiac injury in patients with acute severe dichlorvos poisoning. Methods: Forty patients with acute severe dichlorvos poisoning admitted from December 2009 to December 2011 in our hospital were enrolled in the routine treatment of atropine and chlorophenanthroline. Serum creatine kinase CK-MB, CTNI, AchE, Ach, EPI and noradrenaline (NorP) were measured to analyze the relationship between serum catecholamine levels and cardiac injury Relationship. Results: Of the 40 patients, 34 survived and 6 died. Tachyarrhythmia was observed in 35 cases and electrocardiogram (ECG) ST-T in 36 cases. Serum CK-MB and CTNI were significantly higher , First increased then decreased and then returned to normal at discharge. The difference was statistically significant (CK-MB: H = 8.782, P = 0.002; CTNI: H = 5.017, P = 0.024). Ach admission on the first day of the highest, gradually decreased, discharged to the normal level after discharge, the difference was statistically significant (H = 9.235, P = 0.002; AchE on admission the first day of the lowest, gradually increased to normal, the difference was statistically significant (H = 46.891, P = 0.001). The changes of epinephrine (EPI) and norepinephrine (NorP) on catecholamines peaked on the day of admission, then decreased gradually and the discharge returned to normal with the difference statistically significant (EPI: H = 16.031, P = 0.021; NorP: H = 57.913, P = 0.025) .Further analysis showed that the levels of EPI and NorP were positively correlated with CK-MB and CTNII, respectively, and the differences were statistically significant (P <0.05) .Conclusion: In the case of dichlorvos poisoning, the release of catecholamines and acetylcholine increased, which may cause myocardial damage or aggravate the severity of myocardial ischemia.