老年人重度急性有机磷农药中毒的临床研究

Clinical research on severe acute organophosphorus pesticide poisoning in older adults

目的探讨老年人重度急性有机磷农药中毒(acute organophosphorus pesticide poisoning,AOPP)的临床特点及治疗经验,提高其抢救成功率。方法重度AOPP老年患者62例,按抢救常规彻底清除毒物,尽早使用氯磷定,长托宁治疗29例,阿托品治疗33例,其中联合血液灌流25例,其余37例未行血液灌流。观察两组治疗效果(治愈率、死亡率)、住院天数及不良反应和呼吸衰竭发生率。结果长托宁组:治愈率为96.6%,死亡率为3.4%,住院天数为(11±3.5)d,不良反应发生率为10.3%,呼吸衰竭发生率为17.2%。阿托品组:治愈率为90.9%,死亡率为9.1%,住院天数为(15±4.1)d,不良反应发生率42.4%,呼吸衰竭发生率为33.3%。血液灌流组:住院天数为(8.0±3.5)d,呼吸衰竭发生率为8.0%。未血液灌流组:住院天数为(14±8.0)d,呼吸衰竭发生率为37.8%。结论抢救老年重度AOPP,长托宁和阿托品均有很好疗效,但应用长托宁可缩短住院天数,同时降低不良反应发生率。血液灌流可使住院天数缩短,呼吸衰竭发生率降低。

To explore the clinical features and therapeutic experience in elderly patients with severe acute organophosphorus pesticide poisoning（AOPP） and improve the success rate of rescue. Methods 62 elderly patients with severe AOPP, the toxins was eliminated and pralidoxime chloride were used early according to rescue general. The penehyclidine hydrochloride injection was used in 29 cases, atropine was used in 33 cases, which were combined with hemoperfusion in 25 cases, the remaining 37 cases were without blood perfusion. The treatment effect, hospital day, the incidence of adverse reac- tion and respiratory failure of two groups were observed. Results The cure rate was 96.6%, the mortality rate was 3.4%, hos- pital day was（11±3.5）d, adverse occurrence rate was 10.3%,and the respiratory failure occurred at a rate of 17.2% in penehy- clidine hydrochloride injection group. The cure rate was 90.9%, the mortality rate was 9.1%, the hospital day was（15±4.1）d, adverse reaction occurred at a rate of 42.4%, and the respiratory failure occurred at a rate of 33.3% in atropine group. The hos- pital day was（8.0±3.5）d, respiratory failure occurred at a rate of 8.0% in the hemoperfusion group. The hospital day was（14± 8）d, respiratory failure occurred at a rate of 37.8% in the no-hemoperfusion group. Conclusion The effect of penehyclidine hydrochloride injection and atropine are obvious in the rescue of senile patients with severe AOPP,but the application of hy- drochloride injection can shorten the hospitalization, reduce the incidence of adverse reactions. Hemoperfusion can shorten the hospital day and reduce the incidence of respiratory failure.