长托宁与阿托品治疗急性有机磷农药中毒的疗效对比分析

Comparison of penehyclidine hydrochloride and atropine in the treatment of acute organophosphorus pesticide poisoning

目的比较长托宁与阿托品治疗急性有机磷农药中毒(acute organophosphorus pesticide poisoning,AOPP)的临床效果和可行性。方法将2005-2009年收治的应用阿托品治疗的有机磷农药中毒65例作为阿托品组,将2007-2011年收治的应用长托宁治疗的有机磷农药中毒65例作为长托宁组。2组均给予一般治疗和使用胆碱酯酶(ChE)复能剂,阿托品组在此基础上单用阿托品治疗,长托宁组轻、中度中毒患者单用长托宁治疗,重度中毒患者采用长托宁与阿托品联合疗法。观察2组阿托品或长托宁化时间、ChE恢复时间、住院时间、阿托品中毒、并发症发生和病死率。结果 2组阿托品或长托宁化时间、ChE恢复时间相同中毒程度比较差异无统计学意义(P>0.05),但阿托品组重度中毒者住院时间长于长托宁组(P<0.05),轻度和中度中毒2组住院时间比较差异无统计学意义(P>0.05)。阿托品组重度中毒患者阿托品中毒、并发症发生率及病死率均高于长托宁组,差异有统计学意义(P<0.05,P<0.01)。结论长托宁可明显减少阿托品中毒和并发症发生率,降低病死率,缩短住院天数,使用安全可靠,可作为救治AOPP的首选抗胆碱药物。

Objective To compare the clinical effect and feasibility of penehyclidine hydrochloride and atropine in the treatment of acute organophosphorus pesticide poisoning （AOPP）.Methods 65 cases of patients with AOPP who were treated with atropine were selected as the atropine group from 2005 to 2009; 65 cases of patients with AOPP who were treated with penehyclidine hydrochloride were selected as the penehyclidine hydrochloride group from 2007 to 2011.Both groups were given general treatment and cholinesterase reactivators for treatment.The atropine group was treated with atropine only based on this.In penehyclidine hydrochloride group,the mild and moderate poisoning patients were administered with penehyclidine hydrochloride only; the grave poisoning patients were treated with penehyclidine hydrochloride and atropine.The time of reaching the best effect of penehyclidine hydrochloride or atropine time,the recovery time of cholinesterase（ChE）,the time of hospitalization,atropine poisoning,complications and the number of death were observed.Results The time of reaching the best effect of penehyclidine hydrochloride or atropine time,the recovery time of cholinesterase had no significant difference between 2 groups （P0.05）.There was significant difference between 2 groups of severe poisoning in the time of hospitalization （P0.05）.There was no significant difference between 2 groups of mild and moderate poisoning in the time of hospitalization （P0.05）.The atropine poisoning,complications and the number of death of atropine group were all higher than those of the penehyclidine hydrochloride group,and the differences were statistically significant （P0.05,P0.01）.Conclusion The penehyclidine hydrochloride would significantly reduce the occurrence of atropine poisoning and complications,reduce the mortality, shorten the hospitalization days.The use of penehyclidine hydrochloride would be safe and reliable,it can be used as the first choice of anticholinergic drug in the treatment of acute organophosphorus pesticide poisoning.