适时机械通气策略与大剂量氯磷定在重度有机磷中毒所致急性呼吸衰竭中的临床应用评价

Clinical effects of timely mechanical ventilation combined with large dosage of pyraloxime methylchloride in treatment of acute organophosphorus pesticide poisoning with acute respiratory failure

目的探讨适时机械通气策略在重度有机磷中毒(AOPP)所致急性呼吸衰竭(ARF)的临床应用价值。方法自2003年3月至2007年8月使用适时机械通气策略治疗重度AOPP所致ARF患者21例为治疗组,以适时机械通气为治疗重点,在维持阿托品化基础上,给予大剂量氯磷定。选择1998年5月至2002年10月采用常规方法治疗重度AOPP所致ARF患者19例作为对照组,观察两组机械通气时间、住ICU时间、氯磷定剂量、阿托品用量、中间综合征(IMS)发生率、救治成功率。结果治疗组机械通气时间为(115.3±86.2)h,显著短于对照组[(168.4±110.7)h,P<0.05]。治疗组住ICU时间为(12.1±4.5)d,显著短于对照组[(18.3±9.6)d,P<0.05]。治疗组3d内氯磷定总量(20.2±2.0)g,显著大于对照组[(8.0±3.0)g,P<0.01]。治疗组中间综合征发生率(23.8%,5/21),显著少于对照组[52.6%(10/19),P<0.05]。治疗组阿托品用量为(292.5±115.7)mg,显著低于对照组[(570.3±150.2)mg,P<0.01]。治疗组抢救成功率为85.7%(18/21),显著高于对照组[47.4%(9/19),P<0.01]。结论适时机械通气策略并大剂量氯磷定治疗AOPP所致ARF疗效显著。

Objective To investigate the clinical effects of timely mechanical ventilation （MV） combined with large dosage of pyraloxime methylehloride （PAM-C1） in the treatment of acute organophosphorus pesticide poisoning （AOPP） with a- cute respiratory failure（ARF）. Methods The treatment strategy of timely MV combined with large dosage of PAM-C1 based on atmpinization was used on 21 AOPP cases between March 2003 and August 2007 as treatment group, and 19 AOPP cases receiving routine treatment between May 1998 and October 2002 were used as control group. The MV time, ICU stay time, dosage of PAM-C1, atropine dosage, rate of middle syndrome, and successful rescue rate were compared. Resu I ts The time of MV of the treatment group was （115.3±86.2） h, significantly shorter than that of the control group [（168.4±110.7） h, P〈0.05]. The ICU stay time of the treatment group was （12.1±4.5） days, significantly shorter than that of the control group [（18.3±9.6） days,P〈0.05]. The dosage of PAM-C1 within 3 days of the treament was （20.2±2.0） g, significandy higher than that of the control group [（8.0±3.0）g, P〈0.01]. The rate of intermediate syndrome happened was 23.8%（5/21）, significantly lower than the control group [52.6%（10/19）, P〈0.05]. The dosage of atropine of the treatment group was （292.5±115.7） mg, significantly lower than that of the control group [（570.3 ±150.2 ）mg, P〈0.01]. The successful rescue rate of the treatment group was 85.7%（18/21）, significantly higher than that of the control group （47.4%, P〈0.01）. Conclusion The strategy of timely MV with large dose of PAM-C1 is safe and effective in the treatment of AOPP with ARF.