小儿急性有机磷农药中毒联合应用长托宁、阿托品的临床观察

Effects of combined application of short acting and long acting anti-cholinergic drugs in acute organophosphorus pesticide poisoning

目的探讨长、短效抗胆碱药联合应用对小儿急性有机磷农药中毒（AOPP）临床疗效。方法将60例AOPP患儿，随机分为观察组和对照组，每组30例。观察组应用阿托品、长托宁联合治疗；对照组应用阿托品治疗。两组患儿均给予反复洗胃、应用胆碱酯酶复1110、保肝护胃等治疗。观察患儿生命体征及皮肤情况；阿托品用量、阿托品化时间、胆碱酯酶活力恢复至50％以上时间及住院时间；中毒反跳、阿托品中毒、药物耐受、药物依赖、中间综合征、迟发性神经病及死亡例数。结果观察组较对照组的生命体征平稳，阿托品化时间、胆碱酯酶活力恢复至50％以上时间及住院时间均较短；阿托品用量较小，中毒反跳、阿托品中毒、药物耐受、药物依赖、中间综合征、迟发性神经病发生率显著较低（P〈0．05，P〈0．01）。结论阿托品、长托宁联合应用较单用阿托品救治AOPP使患儿平稳度过危险期，提高疗效，缩短病程，是临床较好的联合用药。

Objective To investigate the clinical effects of combined application of long and short acting anti-cholinergic drugs on acute organophosphorus pesticide poisoning （AOPP） . Methods 60 children with AOPP were randomly assigned to 2 equal groups： observation group and control group. The observation group Imdergwent intramuscular injection of penehyclidine hydroehloride 0.02- 0.04 mg/kg per 4- 6 h till the acetylcholinesterase （CHE） activity recovered to over 50%, and when necessary atropine 20 mg was injected by micropump; and control group underwent continuous injection of atropine 20 mg only. In both groups atropine injection was stopped when the CHE activity recovered to over 80%. In addition, both groups were given gastric lavage, cholinesterase reactivators, etc. The vital signs and skin condition, atropine dosage, atropinization time, time of recovery of CHE activity to more than 50%. and length of hospitalization, poisoning rebound, atropine poisoning, drug tolerance, drug dependence, intermediate syndrome, delayed neuropathy and death were observed. Results Compared with the control group, in the observation group the vital signs were significantly more stable, the atropinization time, time for the CHE activity to recover to more than 50% , and length of hospital stay were significantly shorter; the dosage of atropine, and the incidence rates of poisoning rebound, atropine poisoning, drug tolerance, drug dependence, intermediate syndrome and delayed neuropathy were all lower （P 〈0.05, P 〈0.01）. Conclusion Combined use of short and long acting anti-cholinergic drugs （atropine and penehyclidine hydrochloride） helps the AOPP patients recover more smoothly and improve the curative effects.