氯解磷定不同使用方式联合消旋山莨菪碱在急性有机磷中毒患者中的应用效果观察

Observation on the effect of different ways of using pralidoxime chloride combined with racemic anisodamine in patients with acute organophosphorus poisoning

目的观察氯解磷定不同使用方式联合消旋山莨菪碱在急性有机磷中毒患者中的应用效果。方法选取北京怀柔医院120急救分中心2018年6月~2023年6月纳入的95例急性有机磷中毒患者,按照随机数字法分为对照组(n=47)和观察组(n=48),其中对照组给予氯解磷定2.0 g加入0.9%氯化钠注射液250 ml静脉滴注+阿托品治疗,观察组给予氯解磷定1.0 g负荷量缓脉静脉推注后再用氯解磷定1.0 g加入0.9%氯化钠注射液250 ml静脉滴注+阿托品+消旋山莨菪碱注射液治疗。比较两组患者的用药量、阿托品化时间、血气分析结果和治疗情况。结果治疗后,观察组患者的氯解磷定用药量大于对照组,观察组患者的阿托品用药量小于对照组,差异均有统计学意义(P<0.05)。治疗后,观察组患者的阿托品化时间、血气分析结果均优于对照组,且差异具有统计学意义(P<0.05)。治疗后,观察组患者的消化道出血率、死亡率和阿托品不良反应发生率均低于对照组,且差异具有统计学意义(P<0.05)。结论急性有机磷中毒患者采用氯解磷定1.0 g负荷量缓脉静脉推注后,再用氯解磷定1.0 g加入0.9%氯化钠注射液250 ml静脉滴注+阿托品+消旋山莨菪碱注射液治疗优于给予氯解磷定2.0 g加入0.9%氯化钠注射液250 ml静脉滴注+阿托品治疗,可以有效减少阿托品的用药量,降低死亡率和消化道出血率。

Objective To observe the effect of different ways of using pralidoxime chloride combined with racanisodamine in patients with acute organophosphorus poisoning.Methods A total of 95 patients with acute organophosphorus poisoning enrolled in the 120 Emergency Branch of Beijing Huairou Hospital from June 2018 to June 2023 were selected and divided into the control group(n=47)and the observation group(n=48)according to random number method.The control group was treated with 2.0 g of praloxime chloride plus 0.9% sodium chloride injection 250 ml static point+atropine,while the observation group was treated with 1.0 g of praloxime chloride plus 0.9% sodium chloride injection 250 ml static point+atropine+racemic anisodamine injection.The dosage,atropinization time,blood gas analysis results and treatment status of the two groups were evaluated.Results After treatment,the dosage of praloxime chloride in the observation group was higher than that in the control group(P<0.05),and the dosage of atropine in the observation group was lower than that in the control group(P<0.05).After treatment,the atropinization time and blood gas analysis results of the observation group were better than those of the control group,and the differences were statistically significant(P<0.05).After treatment,the rate of gastrointestinal bleeding,mortality and incidence of atropine adverse reactions in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05).Conclusion The treatment of patients with acute organophosphorus poisoning with 1.0 g load of pralidoxime chloride followed by 1.0 g of pralidoxime chloride plus 0.9% sodium chloride injection 250 ml static point+atropine+racemic anisodamine injection is better than that of pralidoxime chloride 2.0 g plus 0.9% sodium chloride injection 250 ml static point+atropine.It can effectively reduce the dosage of atropine,reduce mortality and gastrointestinal bleeding rate.