探讨急性重度有机磷农药中毒致呼吸衰竭患者的临床急诊急救措施

Study on Clinical Emergency Measures for Patients with Respiratory Failure Caused by Acute Organophosphorus Pesticide Poisoning

目的 探讨急性重度有机磷农药中毒致呼吸衰竭患者采用急救措施取得的临床效果。方法 随机选取该院2008年1月-2014年5月间收治的40例急性重度有机磷农药中毒致呼吸衰竭患者,给予患者采取急救措施,观察患者的临床效果。结果 40例患者中因呼吸衰竭引起的多器官功能衰竭,死亡6例,其余34例均在急救诊治后治愈,治愈率达到85.0%,患者采用机械通气治疗,通气时间为4~11 h,平均通气时间（8.5±2.1）h,患者在入院前血氧饱为（52.8±4.5）%,经过7 d的治疗,患者的血氧饱和度为（95.4±3.4）%,差异具有统计学意义,P〈0.05;患者在治疗前胆碱脂酶为（3854.8±152.4）U/L,经过7 d的治疗,患者的胆碱脂酶为（6978.2±245.2）U/L,差异具有统计学意义,P〈0.05。结论 急性重度有机磷农药中毒致呼吸衰竭患者采取机械通气治疗,能够有效的缓解患者缺氧,提高救治成功率,同时对患者进行洗胃、清除口鼻以及呼吸道分泌物、注射阿托品及氯解磷定等辅助治疗,治疗效果显著,值得在临床急诊中推广应用。

Objective To discuss the clinical effect of the application of emergency measures for patients with respiratory failure caused by acute organophosphorus pesticide poisoning. Methods 40 cases of patients with respiratory failure caused by acute organophosphorus pesticide poisoning treated in our hospital from January 2008 to May 2014 were selected and given emergency measures, the clinical effect of the two groups was observed. Results Of the 40 cases with multiple organ failure caused by respiratory failure, 6 cases died, the other 34 cases were cured after emergency treatment, and the cure rate reached 85.0%, the patients were treated with mechanical ventilation, the duration of ventilation was 4-11 h, the average duration of ventilation was（8.5±2.1）h, the degree of blood oxygen saturation was（52.8±4.5）% before admission and（95.4±3.4）% after 7d of treatment, the difference was statistically significant P0.05, the cholinesterase was（3854.8±152.4）U/L before treatment and（6978.2±245.2）U/L after 7d of treatment, the difference was statistically significant P0.05. Conclusion Mechanical ventilation treatment for patients with respiratory failure caused by acute organophosphorus pesticide poisoning can effectively relieve the patient＇s oxygen deficit and improve the treatment success rate, at the same time, the adjuvant treatment such as gastric lavage, clearance of ？oral and nasal？ and respiratory secretions and injection of atropine and pralidoxime chloride has an obvious treatment effect, which is worthy of promotion and application in clinical emergency.