东莨菪碱治疗急性重度杀虫脒中毒的效果

Effect of scopolamine on the acute severe chlorphenamidine poisoning patients

目的研究东莨菪碱用于抢救急性重度杀虫脒中毒的治疗效果。方法72例急性重度杀虫脒中毒患者按入院先后次序，以1：1抽样原则分为Ⅰ、Ⅱ两组。Ⅰ组（36例）应用传统综合疗法，即洗胃、导泻、使用氧化还原剂（亚甲蓝和维生素c）和对症治疗等；Ⅱ组（36例）在传统综合疗法的基础上，加用东莨菪碱。所有患者在入院时、人院后3、7、12、24h均检测高铁血红蛋白水平；在人院后3、7、24、48h检测血清肌钙蛋白（CTn）Ⅰ和肌酸激酶同工酶（CK．MB）及肝、肾功能；每4h检查1次心电图（ECG），共3d。比较两组患者的疗效及检测指标变化。结果Ⅰ组治愈31例（86．11％），死亡5例（13．89％）；Ⅱ组36例全部治愈；Ⅱ组治愈率明显高于Ⅰ组，差异有统计学意义（P〈0．05）。Ⅱ组患者平均病情好转时间和平均住院天数均明显短于Ⅰ组，差异有统计学意义（P〈0．01）。Ⅱ组病例人院后7、24、48h血清中CtnI水平和3、7、24、48h血清中CK-MB水平均明显低于Ⅰ组，差异有统计学意义（P（0．05或P〈0．01）。人院后3、7、12、24h，Ⅱ组病例的高铁血红蛋白浓度均明显低于Ⅰ组，差异有统计学意义（P〈0．01）。人院后3、24、48h，Ⅱ组患者肝、肾功能异常率明显低于Ⅰ组，差异有统计学意义（P〈0．05）。Ⅱ组患者入院后第2、3天的ECG异常率（38．89％、11．11％）明显低于Ⅰ组（64．71％、38．71％），差异有统计学意义（P〈0．05）。结论东莨菪碱对治疗急性重度杀虫脒中毒有效，对心、肝、肾等重要器官有保护作用，可弥补氧化还原剂药理作用的不足。

Objective To investigate effectiveness of scopolamine on the acute severe chlorphenamidine poisoning patients. Methods 72 cases of acute severe chlorphenamidine poisoning patients were divided intoⅠ and Ⅱ groups by the principle of a 1：1 sampling according to the order of admission. The Ⅰ group （36 cases） were treated with traditional muhimodality therapy, including gastrolavage, catharsis, using reductant-oxi- dant （methylthioninium chloride and vitamin C）, and symptomatic treatment. The Ⅱ group were treated with traditional muitimodality therapy and scopolamine at the same times. Blood methemoglobin were measured at 0, third, seventh, twelfth, twenty-fourth hour, serum troponin Ⅰ （CTnI） and creatine kinase isoenzyme （CK-MB） levels at third, seventh, twenty-fourth, forty-eighth hour, hepatic and renal functions at third, twenty-fourth, forty-eighth hour, and electrocardiogram （ECG） were evaluated every 4 hours in 3 days after hospitalization on all patients. The two groups of patients were compared the efficacy and change detection of targets. Results 31 patients （86.11% ） recovered and 5 patients （13.89%） died in Ⅰ group. All 36 cases recovered in II group. The recovery rate of Ⅱ group was distinctively higher than that in Ⅰ group （P〈0.05） and the difference was statisti- cally significant （P〈0.05）. The average recovery time and the length of hospital stay in Ⅱ group were sharply shorter than those in I group （P〈0.01） and the difference was statistically significant （P〈0.05）. Serum CTnI levels between seventh hour and forty-eighth hour, serum CK-MB levels between third hour and forty-eighth hour and methemoglobin concentration at third,seventh, twelfth, twenty-fourth hour were apparently lower in Ⅱ group, and the difference was statistically significant （P〈0.05）. The abnormal rates of hepatic and renal func- tions in II group were distinctively lower than those in Ⅰ group and the difference was statistically significant （P〈 0.05）. The abnormal rates of ECG in the second and third day in Ⅱ group were respectively 38.89% and 11.11%, and were lower than those in Ⅰ group （64.71% ,38.71% ）. The difference was statistically significant （P〈0.05）. Conclusion Scopolamine has the excellent treatment effect on acute severe chlorphenamidine poisoning patients and protec their hearts, livers, and kidneys. It complements the deficiency of reductant-oxi- dants, and combination of the two drugs can form the synergy effect.