阿托品、长托宁不同时机联合治疗急性有机磷农药中毒

Effects of Atropine Combined with Penehyclidine on Patients with AOPP at Different Time Periods

目的观察阿托品、长托宁不同时机联合治疗重度急性有机磷农药中毒(AOPP)的疗效。方法将89例重度AOPP患者,随机分为开始联合组(43例)和阿托品化联合组(46例)。开始联合组,在开始治疗时阿托品即联合长托宁;阿托品化联合组,先用阿托品达阿托品化后再与长托宁联合,维持阿托品化状态。动态观察胆碱酯酶(CHE)活力,记录阿托品化时间、住院时间和中间综合症、死亡、有机磷中毒反跳、阿托品中毒发生数,分析两组的临床疗效。结果阿托品化联合组与开始联合组比较,阿托品化时间、CHE活力恢复50%时间及住院时间明显缩短[阿托品化时间:(54.6±18.3)min比(65.3±23.1)min,P<0.01,CHE活力恢复时间:(4.2±1.9)d比(5.3±2.6)d,住院时间:(15.1±5.6)d比(18.2±6.8)d,均P<0.05],中毒反跳、阿托品中毒的发生率明显降低(中毒反跳:2.1%比13.9%,阿托品中毒:4.3%比18.6%,均P<0.05)。结论先用阿托品快速达阿托品化后,再用小剂量阿托品、长托宁联合应用维持阿托品化状态治疗重度AOPP,疗效优于开始联合治疗组,可减少并发症的发生,使患者平稳度过危险期,缩短住院时间。

Objective To observe the effect of atropine combined with penehyclidine on patients with severe acute organophosphorus pesticide poisoning（AOPP） at different time periods. Methods Total 89 cases of severe AOPP were randomly divid- ed into early group（43 cases） and atropinization group（46 cases）. The patients in the early group were treated immediately with atropine combined with penehyclidine at beginning of treatment. The patients in the atropinization group were treated with atropine firstly until the phase of atropinization and then both with atropine and penehychdine to keep the atropinization. CHE activity was examined dynamically. The time to atropinization, length of hospital stay, intermediate syndrome, incidence of mortality, the number of poisoning bounce and incidence of atropine poisoning were recorded. The curative effect was compared between the two groups. Results The time to atropinization, ChE recovery at 50 of normal ChE activity and length of hospital stay decreased significantly in the atropinization group as compared to the early group（ P 〈 0.05 ） ; the incidence of poisoning bounce and atropine poisoning decreased obviously in the atropinization group（ P 〈 0.05 ）. Conclusion After quickly reaching the atropinization with atropine, then keeping the atropinization with a small dose of atropine and penehyclidine can reduce the incidence of complications and reduce the hospital delay in the treatment of severe AOPP.