阿托品与长托宁不同时机联合对重度急性有机磷农药中毒疗效的影响

Effects of atropine and penehyclidine with different opportunity combination on severe acute organophosphate pesticide poisoning

目的观察阿托品、长托宁在不同治疗时机联合对重度急性有机磷农药中毒（AOPP）疗效的影响。方法将89例重度AOPP患者，随机分为开始联合组（43例）及阿托品化联合组（46例），开始联合组在入院后即行阿托品、长托宁联合治疗，阿托品化联合组应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）活力变化，记录中毒反跳、阿托品中毒、中间综合征发生数、死亡数、阿托品化时间及住院时间，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，（P〈0．05），住院时间：（15．1±5．6）d比（18．2±6．8）d，（P〈0．05）]，中毒反置1b、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％，P均〈0．05），两组中间综合征发生率及病死率比较差异无统计学意义（P均〉0．05）。结论用阿托品快速达阿托品化后，小剂量长托宁联合阿托品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，减少医疗费用。

Objective To observe the influence of atropine, penehyclidine with different oppor- tunity combination on severe acute organophosphate pesticide poisoning （AOPP）. Methods Eighty-nine cases of severe AOPP patients were divided into two groups randomly ： began joint group （43 cases） and atropinization combination group （46 cases）. The began joint group immediately treated with atropine, penehyclidine at hospital admission. The atropinization combination group combined atropine with pene- hyclidine to maintain atropinization state after reaching atropinization with atropine. Dynamically observe the changes of CHE activity, recorded the number of poisoning rebound, atropine poisoning, intermediate syndrome, death and atropinization time, length of stay, the clinical efficacy of two groups were ana- lyzed. Results Compared with the begain joint group, in the atropinization combination group the time of atropinization, CHE activity resumed to 50% and hospitalization was obviously shortened [ atropiniza- tiontime：（54.6 ± 18.3）min to （65.3 ±23.1）min （P 〈0.01）, CHE activity resumed 50% time （4.2±1.9）dto （5.3±2.6）d （P〈0.05）, hospital stays：（15.1±5.6）d to （18.2±6.8） d （P〈 0.05 ）, poisoning rebound, atropine poisoning incidence was lower poisoning rebound ：2. 1% to 13.9% , atropine poisoning：4.3% to 18.6% （P 〈 0. 05）. IMS incidence, mortality have no significant difference average, （P 〉 0.05）. Conclusions After quickly reached atropinization with atropine, small doses of penehyclidine and the joint use of atropine maintain atropinization state treatment of severe AOPP can re- duce the incidence of complications, patients smoothly through dangerous period, reduce hospital stays and cut down medical costs.