有机磷农药中毒并发中间综合征的早期防治

The Early Stage of Prevention and Management of Intermediate Syndrome in Organophosphorus Pesticide Poisoning

目的 :探讨有机磷农药中毒后并发中间综合征 (IMS)的早期防治措施。方法 :将中、重度有机磷农药中毒的 30 5例患者随机开放式分为治疗组 15 8例和对照组 14 7例 ,治疗组采用早期、突击剂量应用胆碱酯酶复活剂的治疗方法 (第 1个 2 4h氯磷啶平均用量 8.4± 1.1g) ,对照组采用传统的治疗方法 (第 1个 2 4h氯磷啶平均用量 3.2 5± 0 .5 g) ,观察两组胆碱酯酶恢复的时间 ,IMS的发生率及病死率 ,胆碱酯酶活力与IMS发生的关系。结果 :治疗组胆碱酯酶平均恢复的时间 (5 .8± 1.5d)较对照组(19.3± 3.5d)明显缩短 (P <0 .0 1) ;治疗组IMS的发生率 (5 .6 6 % )及病死率 (1.89% )较对照组 (2 5 .0 9%和 10 .2 7% )明显降低 (P <0 .0 1) ;并发IMS患者的胆碱酯酶活力均在 6 0 %以下。结论 :早期 (中毒 2h内 )足量 (第 1个 2 4h氯磷啶用量 8～ 10 g)应用胆碱酯酶复活剂是减少有机磷中毒后并发IMS及降低其病死率的有效措施。

Objective: To study the early stage of prevention and management of intermediate syndrome(IMS) in organophosphorus poisoning. Methods: 305 cases of organophosphorus pesticite poisoning were randomized into treatment group (158)and control group (147). The treatment group was treated by cholinesterase reactivators in early and shock dose (first 24h phraloxime methylchloride average volhme 8.4±1.1g ),and the control group was treated by tradition method (first 24h phraloxime methylchloride average volume 3.25±0.5g). We observed the time of the two groups of recovering for cholinesterase and incidence and death rate of IMS, the relations of cholinesterase activity and IMS. Results: The average recover time of treatment group with cholinesterase activity (5.8±1.5d) was significanty shorten than that of control group (19.3±3.5d) ( P <0.01); incidence of IMS (5.66%) and death (1.89%) of treatment group was significanly lower than that of control group (25.09% and 10.27%),( P <0.01);then the cholinesterase activity were lower up 60% for the patients of IMS. Conclusion: The early (Poisoming in 2h) and enough volume (first 24h pyraloxime methglchloride using volume 8～10g) apply cholinesterase reactivators was the effective measure of reducing IMS in organophosphorus poisoning and lower its death rate.