盐酸戊乙奎醚化与盐酸戊乙奎醚过量的临床观察

Clinical observation between penehyclidinezation and excessive use of penehyclidine

目的探讨新型抗胆碱药盐酸戊乙奎醚(长托宁)在急性有机磷农药中毒救治中长托宁化的临床表现,为防止长托宁过量与中毒提供参考。方法急性有机磷农药中毒61例随机分为长托宁治疗组与阿托品治疗组,观察长托宁化与阿托品化的临床指征。结果31例应用长托宁表现长托宁化,其中7例表现长托宁过量。长托宁化主要表现为皮肤干燥、呼吸道分泌物明显减少或消失、瞳孔扩大、精神轻度亢奋、胆碱酯酶活力上升20%以上、中毒症状减轻等,无心跳加快及心动过速。长托宁过量表现为精神亢奋、幻视幻听、抓空摸空、坐卧不宁、躁狂型精神症状等,且持续时间较长。结论长托宁救治急性有机鳞农药中毒应尽快使患者达"长托宁化"。长托宁应用不当会发生过量与中毒表现,长托宁过量主要表现为可逆性精神症状,及时停药,作好自伤与他伤的防护,预后较佳。

Objective To observe the clinical performance of penehyclidinezation through the new anticholinergic drug-penehyclidine in the treatment of acute organophosphorus pesticide poisoning,instructive ideas of preventing the excessive use and poisoning of penehyclidine would be provided. Methods Sixty-one patients with acute organophosphorus pesticide were randomly divided into penehyclidine group and atropine group. The clinical indications were studied between penehyelidinezation and excessive use in penehyelidine group. Results Thirty one patients in the application of penehyclidine had various magnitudes of penehyclidinezation and 7 cases excessive performance. Penehyelidinezation mainly relieved symptoms of poisoning. Pupils became bigger and respiratory secretions significantly reduced or disappeared. With dry skin and excited spirit, the patients may be without rapid heart beat. Cholinesterase could rise more than 20%. Excessive use led to excited spirit,illusion, restlessness and manic symptoms of mental illness and so on. Conclusion It was shown that in the treatment of acute organophosphorus pesticide poisoning,patients should achieve penehyclidinezation as soon as possible. At the same time,the abuse of penehyclidine will result in excessiveness and poisoning. Patients would have obvious mental symptoms if penehyclidine was excessively used. The timely withdrawal and good protection will make better prognosis.