小儿急性有机磷农药中毒院前系统救治的研究

Pre-hospital systematic treatment for children with acute organophosphorus pesticide poisoning

目的探讨小儿急性有机磷农药中毒(AOPP)现场系统救治的可行性,比较长托宁与阿托品院前急救小儿AOPP的疗效。方法 39例小儿AOPP病例,其中长托宁治疗组19例,阿托品对照组20例,两组均联合使用氯磷定。观察两组生存率;存活儿童ChE恢复时间、平均用药次数、平均住院日、中毒症状消失时间及药物不良反应。结果治疗组及对照组生存率分别为94.7%、90%;两组存活儿童出汗、流涎、肺部啰音、瞳孔缩小等症状消失时间,口干、高热发生率比较差异无统计学意义(P>0.05),但治疗组ChE恢复时间、平均用药次数、平均住院日、昏迷持续时间、心动过速及躁动发生率与对照组比较,差异有统计学意义(P<0.05)。结论院前救治AOPP切实可行,长托宁是抢救小儿AOPP较理想的抗胆碱药物。

Objective To explore the feasibility of on - spot systematic treatment for children with acute organophos- phorus pesticide poisoning（AOPP） and to compare the therapeutic effect of penehyclidine hydrochloride with atropine in pre - hospital treatm - ent for children with AOPP. Methods 39 AOPP children were divided into control group （ n = 20 ） and treatment group（ n = 19）. Atropine was used in control group and was replaced by penehyclidine hydrochloride in treat-ment group, both groups were given the joint use of phosphorus chloride. To investigate the survival rate in two groups and the recovery time of ChE, mean time of drug use, hospital days, poisoning symptoms disappeared time, adverse drug reactions in a- live children were also observed. Results The survival rate in treatment group and control group was 94.7% ,90% respec- tively. In surviving children of two groups, the disappearance time of sweating,salivation ,pulmonary rales,miosis and the in- cidence of dry mouth, high fever had no differemce （ P 〉 0. 05 ）, however, the recovery time of ChE, mean times of drug use, hospital days ,stun duration in treatment group were remarkable shorter compared with those in control group and the incidence of tachycardia, restlessness were much lower than those in control group （ P 〈 0. 05 ）. Conclusion Pre - hospital systematic treatment for children with AOPP is effective, penehyclidine hydrochloride as an safe anticholinergic drug can replace atropine during the treatment of AOPP in children.