盐酸戊乙奎醚与阿托品联合应用治疗急性重度有机磷中毒合并呼吸衰竭的临床研究

Efficacy of penehyclidine hydrochloride and atropine in treating patients with acute severe organophosphorus pesticide poisoning and respiratory failure

目的观察盐酸戊乙奎醚(长托宁)和阿托品联合应用抢救急性重度有机磷中毒(ASOPP)合并呼吸衰竭(RF)的效果。方法回顾性分析我院急诊科2006年1月至2009年12月收治的ASOPP合并RF患者56例(均行气管插管,呼吸机辅助/控制呼吸),其中阿托品联合长托宁治疗组(Ⅰ组)31例,阿托品治疗组(Ⅱ组)25例,比较两组患者的住院时间、拔管脱机时间、胆碱酯酶恢复时间、并发症发生率、治愈率、病死率。结果阿托品联合长托宁治疗组和阿托品治疗组患者的住院时间分别为(5.0±1.5)天和(18.0±3.0)天(P<0.01),拔管脱机时间分别为(3.5±1.2)天和(7.0±2.5)天(P<0.01),胆碱酯酶恢复时间分别为(3.0±1.2)天和(13.3±3.5)天(P<0.01);并发症发生率分别为6.5%和44.0%(P<0.01),治愈率分别为96.8%和80.0%(P<0.05),病死率分别为3.2%和20.0%(P<0.05)。结论长托宁与阿托品联合应用治疗ASOPP合并RF,疗效优于阿托品单独治疗。

Objective To investigate the efficacy of penehyclidine hydrochloride and atropine in rescuing patients with acute severe organophosphorus pesticide poisoning（ASOPP） and respiratory failure（RF）.Methods From January 2006 to December 2009,a total of 56 cases with ASOPP and RF were analyzed retrospectively（all patients were intubated,assisted or controlled respiration with ventilator）.Of these cases,31 patients were treated with penehyclidine hydrochloride plus atropine（group Ⅰ） and 25 patients were treated with atropine（group Ⅱ）.The duration of hospitalization and mechanical ventilation,recovery time of acetylcholine estrase（CHE） activity,the occurrence of complication,the incidence of healing and the overall mortality of the two groups were compared,respectively.Results For the patients of groupⅠand group Ⅱ：①the duration of hospitalization was（5.0±1.5） days and（18.0±3.0） days,respectively（P0.01）;②the duration of mechanical ventilation was（3.5±1.2） days and（7.0±2.5） days,respectively（P0.01）;③recovery time of acetylcholine estrase（CHE） activity was（3.0±1.2） days and（13.3±3.5） days,respectively（P0.01）;④the occurrence of complication was 6.5% and 44.0%,respectively（P0.01）;⑤the incidence of healing was 96.8% and 80.0%,respectively（P0.05）;⑥the mortality was 3.2% and 20.0%,respectively（P0.05）.Conclusion Compared with atropine used alone,penehyclidine hydrochloride plus atropine can reduce the complications and enhance the rescue success ratio of ASOPP and RF.