目的 观察早期持续血液净化对有机磷中毒患者血清肿瘤坏死因子α(tumor necrosis faetor-α,TNF-α)、白细胞介素8(interleukin-8,IL-8)及白细胞介素18(interleukin-18,IL-18)水平影响.方法 选择2013年1月-2015年10月在邯郸市第一医院就诊的84例有机磷中毒,随机将其分为观察组44例和对照组40例,在常规治疗基础上,观察组接受早期持续血液净化联合血液灌流治疗,对照组接受早期血液灌流治疗,观察比较两组临床疗效指标、血清炎性因子及并发症发生率、存活率情况.结果 观察组阿托品用量明显少于对照组,胆碱酯酶活性恢复时间、昏迷持续时间、住院总时间均明显短于对照组,差异均有统计学意义(P＜0.05).治疗后1d两组血清TNF-α、IL-8及IL-18水平均较治疗前明显升高,治疗后3、5d两组血清TNF-α、IL-8及IL-18水平均较治疗前明显降低,差异均有统计学意义(P＜0.05).治疗后1、3、5d,观察组血清TNF-α、IL-8及IL-18水平均明显低于对照组,差异均有统计学意义(P＜0.05).治疗后1周观察组低氧血症、呼吸衰竭、肝损伤及肾损伤等并发症发生率均明显低于对照组,发病后30 d观察组存活率明显高于对照组,差异均有统计学意义(P＜0.05).结论 有机磷中毒患者早期应用持续血液净化可促进体内胆碱酯酶恢复活性,减少药物用量,缓解机体炎症状态,从而降低并发症发生率,提高生存率.

Objective:To discuss associated factors of bloodstream infections related with ICU central venous catheter in our hospital,and to provide preven-tion measures. Methods:Retrospective investigation was conducted on conditions of 562 cases of patients treated with central venous catheters in our ICU from January 2010 to January 2015. Relations between infections and all factors were analyzed. Results:Occurrence rate of bloodstream infections related with central venous catheter had no correlations with complicated basic disease(P > 0. 05),but had significant correlations with patient original departments,in-dwelling times,fixation modes and puncture parts of catheter,and patient ages( P < 0. 05). Conclusion:Possible high risk factors of catheter - related bloodstream infections include complicated basic disease,surgery department origin,excessive catheter indwelling time,suture fixation,puncture part other than the subclavian and old age. Related doctors and nurses should adopt targeted prevention measures based on these risk factors,so as to improve security during the use of central venous catheters.

气管插管后非计划拔管(unplanned extubation,UEX)指插管意外脱落或未经医护人员同意,患者将插管拔除,也包括医护人员操作不当所致拔管[1],是气管插管最严重的并发症之一[2].