急性有机磷农药中毒早期血胆碱酯酶变化与临床中毒程度关系的探讨——附96例临床分析

Investigation into the relationship between the extent of clinical intoxication and the change in blood cholinesterase at the early stage of acute organic phosphorus pesticide poisoning:clinical analysis of 96 cases

目的 :探讨急性有机磷农药中毒早期血胆碱酯酶变化与临床中毒程度的关系 ,减少误、漏诊的发生及避免对病情估计不足。方法 :回顾性将近 2年本院收治急性有机磷农药中毒 96例 ,按临床中毒程度分轻、中、重度中毒 3组 ,把就诊和确诊时用纸片法测得的血胆碱酯酶活性与其临床中毒程度相比较 ,观察血胆碱酯酶活性变化与临床中毒程度关系。结果 :2 2例血胆碱酯酶变化与临床中毒程度明显不相符。结论 :急性有机磷农药中毒早期 ,血胆碱酯酶活性变化在诊断及估计病情时只能作参考 ;对可疑中毒者不能因血胆碱酯酶正常而作出否定的结论 ;对诊断明确 ,血胆碱酯酶活性正常而症状明显及血胆碱酯酶活性严重下降而症状轻微者 ,治疗上均不能麻痹大意。

Objective:To investigate the relationship between the extent of clinical intoxication and the change in blood cholinesterase at the early stage of acute organic phosphorus pesticide poisoning in order to reduce misdiagnosis and avoid underestimation of patients conditions.Methods:Retrospective analysis of 96 cases with acute organic phosphorus poisoning who were cured in the last two years was carried out and the patients were divided into three groups (mild,moderate and severe)according to the extent of clinical intoxication.The activity of blood cholinesterase was detected with reagent paper and compared with the extent of clinical intoxication in order to observe the relationship between the extent of clinical intoxication and the change in blood cholinesterase activities.Results:The changes in blood cholinesterase didn't conform to the extent of clinical intoxication in 22 cases.Conclusions:The change of blood cholinesterase activity at the early stage of acute organic phosphorus pesticide poisoning should only be used as a reference in diagnosis and estimation of patients conditions.For the suspected patients with intoxication the diagnosis should not be excluded only because of normal contents of cholinesterase.Otherwise the treatment not only for some cases diagnosed confirmatively who have normal activity of cholinesterase but obvious symptoms,but also for other cases who have significant decrease in cholinesterase activity but slight symptoms should be very careful.