急性有机磷中毒合并中间型综合征的临床研究

Clinical study on severe acute organophosphate poisoning with intermediate syndrome

目的探索急性有机磷中毒合并中间型综合征(IMS)的临床发病及治疗特点。方法选取2014年1月至2016年12月期间收治的急性有机磷农药中毒(AOPP)并发中间型综合征患者60例,对其临床诊疗资料进行回顾性总结分析。结果 60例患者中有10例死亡,死亡率为16.67%,其中8例放弃治疗,2例因呼吸道痰阻致呼吸功能衰竭死亡;有机磷农药中毒后患者出现IMS症状的时间最短为9 h,最长为3.5 d,平均出现时间为中毒后26.5 h;IMS恢复时间为4~27 d,其中48例于14 d内恢复,12例在14~27 d内恢复;机械通气时间为3~17 d,平均7.5 d;脱机时胆碱酯酶活力:18例>70%正常值,30例为50%~70%正常值,12例<50%正常值。结论 AOPP患者一旦出现IMS症状,应及时进行呼吸机通气治疗,同时大量运用胆碱酯酶复能剂和阿托品,通过全面综合性治疗及细致护理,IMS患者可收到较为满意的疗效。

Objective To explore the clinical significance and pathogenesis of severe acute organophosphate poisoning merged intermediate syndrome and its characteristics of treatment.Methods A total of 60 patients with organophosphorus pesticide poisoning intercurrent intermediate syndrome in this hospital during January 2014 to December 2016 were allocated for this study, the clinical data of diagnosis and treatment were retrospectively summarized and analyzed.Results Among these 60 patients, 10 cases died with mortality of 16.67%, 8 of them gave up treatment, the death of 2 cases caused by respiratory phlegm obstruction and respiratory function failure.The shortest time for occurrence of IMS symptoms in patients with organophosphorus pesticide poisoning was 9 h, and the longest was 3.5 d, and the average duration was 26.5 h after poisoning.The recovery period for IMS was 4~27 d, of which 48 cases within 14 d, and 12 cases within 14~27 d.The recovery period for IMS and onset time did not have a positive correlation.The period for mechanical ventilation was 3~17 d, with average of 7.5 d.Off-line cholinesterase activity： 18 cases 〉70% normal value, 30 cases were 50%~70% of normal, 12 cases were 〈50% of normal.Conclusion Patients with AOPP once IMS symptoms occurred, they should be in time for application of breathing machine for ventilation treatment, at the same time a large number of patients had applied of cholinesterase complex and atropine, through thorough comprehensive treatment and careful nursing, patients with IMS can receive a more satisfactory curative effect.