急性混配农药中毒的临床研究

Clinical studies on acute combined pesticides poisoning

目的 了解急性混配农药中毒的临床表现特点 ,以提高混配农药中毒的诊治水平。方法 1996～ 2 0 0 0年在农药中毒高发地区的 6个县市级医院 ,按统一观察表格和检查的要求 ,对急性农药中毒患者进行临床观察和诊治研究。结果 共收治急性混配农药中毒 (混配组 ) 15 6例和急性单剂农药中毒 (单剂组 ) 115例。混配组中 ,含有机磷杀虫剂 (OP)的混配中毒 15 0例 ,含氨基甲酸酯杀虫剂 (CB)不含OP的混配中毒 6例。单剂组中 ,OP中毒 10 9例 ,CB中毒 6例。混配和单剂组患者均以急性胆碱能兴奋或危象为主要临床表现 ,以头晕、乏力、多汗、流涎、恶心、呕吐、瞳孔缩小、肌束震颤多见 ,重者出现昏迷、肺部湿音、大小便失禁 ;两组全血ChE活力均下降 ,范围分别为7%～ 73%和 5 %～ 70 %。在急性中毒 1～ 4天胆碱能危象基本控制后 ,含OP的混配组中 6例以及OP单剂组 9例出现屈颈肌与四肢近端肌肉及脑神经支配的肌肉无力 ,其中混配组 4例及单剂组 6例尚出现呼吸肌无力。参照相关诊断标准及分级建议 ,混配组分别诊断急性轻度、中度和重度混配农药中毒 61例、 67例和 2 8例 ,其中合并轻型中间期肌无力综合征 (IMS) 2例、重型IMS 4例 ;单剂组分别诊断急性轻度、中度和重度单剂农药中毒 2 9例、 35例和 5 1例 。

Objective To explore the clinical features of acute combined pesticides poisoning and to improve its art of the diagnosis and treatment.Methods Clinical observations and studies on diagnosis and treatment of 271 cases of acute pesticides poisoning were conducted in 6 hospitals during the period of 1996～2000.Results The poisoned patients were divided into two groups according to their exposure to single or combined pesticides:acute combined pesticides poisoning group(Group C,156 cases)and acute single pesticide poisoning group(Group S,115 cases).Group C were composed of 150 cases with acute poisoning of pesticide mixtures containing organophosphate(OP) and 6 cases with acute poisoning of pesticide mixtures containing carbamate (CB). Group S comprised 109 cases with OP poisoning and 6 cases with CB poisoning.Acute cholinerigic symptoms and signs were found on their arrival at the hospitals,mainly including dizziness,weakness,profuse sweating,excessive salivation,nausea,vomiting,miosis and muscle fasculations in both groups.Coma,moist rales in the lungs and incontinence of urine and(or) feces were found in the seriously ill cases.The whole blood ChE activities were inhibited in all cases,ranged from 7% to 73% in Group C and 5%～70% in Group S.Weakness of neck flexors and proximal limb muscles as well as muscles innervated by motor cranial nerves occurred about 1～4 days after the onset of acute poisoning in 6 cases exposed to pesticide mixtures containing OP and 9 cases exposed to OP who had already recovered from acute cholinergic crisis,weakness of respiratory muscles were also involved in 4 cases exposed to pesticide mixtures containing OP and 6 cases exposed to OP.Reference to the related criteria of diagnosis and gradation of pesticides poisoning,61,67 and 28 cases in Group C were diagnosed as acute mild,moderate and severe combined pesticides poisoning,out of them 2 cases were complicated with mild Intermediate Myasthenia Syndrome(IMS) and 4 cases with severe IMS;29,35 and 51 cases in Group S were diagnosed as acute mild,moderate and severe single insecticide poisoning,out of them 3 cases were complicated with mild IMS and 6 cases with severe IMS.All patients of oral poisoning had received gastric lavage with 15～30 liters of water and the contaminated areas of the skin were washed with soap and water.Atropine and pralidoxime chloride or iodide were used as specific antidotes.Symptomatic and supportive therapy was also applied,especially to the patients of severe poisoning.Endotracheal intubation and mechanical ventilation were immediately put on for severe IMS cases of respiratory paralysis and maintained until complete recovery of spontaneous respiration.After above comprehensive treatment,264 cases were recovered except 7 cases of severe oral(OP+OP 3 cases,OP 4 cases)poisoning died of respiratory failure.Conclusion The acute poisoning of pesticide mixtures containing ChE-inhibited insecticides can be diagnosed and treated in the similar manner as acute single OP poisoning.