不同有机磷中毒后全血胆碱酯酶变化与临床关系的探讨

A Discussion of the Relationship Between Change of Whole Blood Cholinesterase of Six Type Organophosphorus Pesticide Poisoning and Clinical Significance

目的 探讨 6种有机磷急性中毒后全血胆碱酯酶 (WBChE)的变化特点与临床表现之间的关系。方法 分别对 6种有机磷急性中毒患者就诊时即测WBChE并根据临床表现分度。治疗 72h后观察WBChE的变化和临床表现判定治疗结果。结果2 38例治疗 72小时基本痊愈者WBChE >75% (A) 18.1%、50 %～ 74 % (B) 36 .9%、30 %～ 4 9% (C) 4 5.5%。E6 0 5(PMB >MS<0 .0 0 5) ,乐果 (PMA >SA<0 .0 5)、氧乐果 :MB >SB (PMB >SB<0 .0 5) ,复合农药 (PMC >SC<0 .0 5) ,均有不同程度的差异。DDV中毒酶的重活化能力非常显著高于氧乐果B(P <0 .0 0 5)、E60 5B(P <0 .0 5)、老化能力显著低于氧乐果 (P <0 .0 5)。结论 AOPP后 72hWBChE特点为 :WbChE恢复与临床症状的恢复不一致 ;重度低于中度 ;与毒物的化学结构关系密切 ;DDV中毒酶的恢复高于其他五类 ,氧乐果中毒酶最差 ;在氧乐果、乐果中毒时应延长复能剂的使用时间至 72h。

Objective To investigate the clinical significance and characteristics of reactivation of whole blood cholinesterase (WBChE ) in patients with six type of acute organophosphorus pesticide poisoning( AOPP ). Methods According to the measured WBChE and the manifestation, patients were divided into moderate and severe. After 72 hrs , they was measured again and made definite treatment effect. Results After treated 72h, 238 patients healed within 72h.group A(WBChE>70% ) was 18.1% ;group B(WBChE 50%～69% ) was 36.9% ;group C(WBChE 30%～49% ) was 45.5 % (C). In group B the cases for parathion or omethoate moderate poisoning was significantly higher than that in severe group ( P <0.005, P <0.05) , and in group A the cases for dimethoate moderate poising was significantly higher than that severe group ( P <0.05). In gorup C the cases for compound poison moderate poising was significantly lower than that sever group ( P <0.05). In the same condition reactivation for dichlorvos inhibited WBChE was very significantly higher than that omethoate inhibited ( P <0. 005) ,and significantly higher than that parathion inhibited( P < 0.05). The aging for dichlorvos inhibited WBChE was very significantly lower than that omethoate inhibited ( P <0. 005). Conclusions After 72 hrs of AOPP the changed characteristic of WBChE was: The recovery rate of WBChE was not as same as that the clinical symptoms; Severe was lower than that moderate; It is related to the degree and poison chemical structure. The reactivation rate for dichlorvos-inhibited WBChE was the highest of the six types poison and omethoate - inhibited WBChE was the lowest of that. If it is poison for omethoate, the re-activator with oxime will be taken until 72 hrs.