急性有机磷农药中毒并呼吸肌麻痹患者阿托品维持用量探讨

Study on the Proper Dose of Atropine in the Respiratory Supporting Therapy of Respiratory Muscle Paralysis Caused by Acute Organophosphorus Pesticide Poisoning

目的探讨对急性有机磷农药中毒并呼吸肌麻痹患者呼吸支持过程中阿托品的合理用量。方法收集2000年6月～2004年6月我院收治的99例急性有机磷农药中毒并呼吸肌麻痹患者的病例资料。按阿托品的不同用量进行阶梯式分组,共分9组。对各组患者的阿托品用量不足及过量中毒的发生率、病死率、阿托品维持时间、呼吸机脱机时间、住院时间进行比较,并进行统计学处理。结果阿托品维持用量在2mg/h 以下者(Ⅰ、Ⅱ组)阿托品用量不足发生率、病死率均高于其它组(P<0.05);阿托品维持用量在2～5 mg/h,维持3～5 d 后逐渐减量直到完全恢复为自主呼吸者(Ⅲ-Ⅵ组)阿托品用量不足及过量中毒发生率、病死率均为0;阿托品维持用量在10～20 mg/h(Ⅶ、Ⅷ组)阿托品维持时间、脱机时间、住院时间相应延长(P<0.05);各组治愈患者氯磷啶应用总量、维持时间无显著差异(P>0.05)。结论急性有机磷农药中毒并呼吸肌麻痹患者行呼吸支持期间,阿托品用量维持在2～5 mg/h 是提高治愈率降低病死率的理想用量。

Objective To investigate the proper dose of atropine in the therapy of respiratory muscle paralysis（RMP） caused by acute organophosphorus pesticide poisoning（AOPP） during artificial ventilation. Methods 99 cases of RMP caused by AOPP were divided into 9 groups according to the maintaining dose of atropine. The occurring rate of atropine deficiency and atropine poisoning mortality, the survival rate, lasting time of atropine, the time of freeing of breathing machine, the mean hospitalization days were compared. Results The occurring rate of atropine deficiency and mortality was higher in group Ⅰ and Ⅱ （ 〈2 mg/h atropine） than in any other group（ P 〈0. 05）. No atropine deficiency or atropine poisoning occurred in group Ⅲ ～ Ⅵ （2 ～ 5 mg/h atropine）. The lasting time of atropine, the time of freeing of breathing machine and the mean hospitalization days are longer in group Ⅶ and Ⅷ than in any other groups （ P 〈 0.05 ）. Conclusion The maintaining dose of atropine with 2 ～ 5 mg/h to maintain atrepinization during artificial ventilation is ideal dose in improving curative rate and decreasing mortality of patients with RMP caused by AOPP.