长托宁抢救重度有机磷农药中毒疗效观察

Therapeutic effect of Penehyclidine Hydrochloride to rescue severe acute organophosphorus pesticide poisoning

目的:比较观察阿托品和盐酸戊乙奎醚(商品名:长托宁)分别用于重度有机磷中毒(acute organophosphorus pesticide poisoning,AOPP)抢救的疗效。方法:选择60例重度AOPP患者,随机分成长托宁+氯解磷定组(P组)及阿托品+氯解磷定组(A组),各30例,两组基础治疗相同,P组肌注长托宁4～6 mg,氯磷定2.0～3.0 g静脉注射;A组给予阿托品首剂10～20 mg静脉注射后间断维持,同时氯磷定2.0～3.0 g静脉注射,观察记录两组患者毒蕈碱样症状消失时间、烟碱样症状消失时间、中枢神经系统症状消失时间及胆碱酯酶活力恢复60%时间,统计各组治愈率、住院时间及严重并发症发生率,观察药物不良反应发生情况。结果:P组患者蕈碱样症状消失时间、烟碱样症状消失时间、中枢神经系统症状消失时间及胆碱酯酶活力恢复60%时间均低于A组(P<0.05),P组胆碱酯酶活力恢复明显较A组快,P组治愈率高于A组(P<0.05),P组住院时间较A组缩短,严重并发症发生率及药物不良反应发生率P组均低于A组(P<0.05)。结论:长托宁能有效缓解重度AOPP症状,促进胆碱酯酶活力恢复,不良反应少,是较阿托品更为理想的重度AOPP治疗药物。

Objective： To compare the therapeutic effect of Atropine and Penehyclidine Hydrochloride used for severe acute organophosphorus pesticide poisoning （AOPP）. Methods： 30 cases of severe acute organophosphorus pesticide poisoning were selected and divided into Penehyclidine Hydrochloride ＋ Pyraloxime Chloride group （group P） and Atropine ＋ Pyraloxime Chloride group （group A） randomly. The same basic treatment was given, 4-6 mg Penehyelidine Hydrochloride im and 2.0-3.0 g Pyraloxime Chloride iv for group P, 10-20 mg initial dose of Atropine iv and 2.0-3.0 g Pyraloxime Chloride iv for group A. Then extinction time of M sample, extinction time of N sample, extinction time of CNS sample and time of recovery 60% ChE activity were observed, cure rate, LOS, severe complications rate and drug adverse reaction incidence were calculated. Results： Extinction time of M sample, extinction time of N sample, extinction time of CNS sample and time of recovery 60% ChE activity of group P were shorter than group A （P〈0.05）, ChE activity recovered faster in group P, cure rate of goup P was higher （P〈0.05）, LOS of goup P was shorter （P〈0.05）, severe complications rate and drug adverse reaction incidence were also lower in group P （P〈0.05）. Conclusion： Penehyclidine Hydrochloride can effectively relief symptom of severe AOPP, and promote recovery of ChE activity with less adverse effect, it is a kind of anticholinergic drug which is more ideal than Atropine for severe AOPP treatment.