不同剂量长托宁治疗SAOPP伴呼吸衰竭的效果分析

Analysis of the effect of different doses of Changtuoning in the treatment of SAOPP with respiratory failure

目的比较不同剂量长托宁治疗重症有机磷农药中毒(SAOPP)伴呼吸衰竭的效果及安全性。方法将60例SAOPP伴呼吸衰竭患者随机分为大剂量组(n=30)与小剂量组(n=30)。大剂量组首次肌内注射长托宁4～6 mg,0.5 h后再次注射2～3 mg,阿托品化后剂量改为1～2 mg维持治疗;小剂量组长托宁用量减半。比较两组治愈率、血胆碱酯酶(CHE)恢复和临床症状消失时间,以及治疗前后心肺功能变化和不良反应。结果两组治愈率、CHE恢复时间、临床症状消失时间比较均无明显差异(P> 0.05);治疗后5、7 d,两组血清肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、左心室射血分数(LVEF)、氧耗量(VO_2)、二氧化碳生成量(VCO_2)、每分钟通气量(VE)也无明显差异(P> 0.05);但小剂量组口干、躁动发生率明显低于大剂量组(P <0.05)。结论小剂量长托宁治疗SAOPP中毒伴呼吸衰竭患者,可达到与大剂量长托宁相同的效果,且不良反应较少,安全性更好。

Objective To compare the efficacy and safety of different doses of Changtuoning in the treatment of severe acute organophosphorus pesticide poisoning (SAOPP) with respiratory failure. Methods A total of 60 SAOPP patients with respiratory failure were randomly divided into a high-dose group and a low-dose group (n =30, respectively). In the high-dose group, the first intramuscular injection dose of Changtuoning was 4-6 mg, and the second dose was 2-3 mg after 0.5 h;after atropinization, the dose of Changtuoning was changed to 1-2 mg for a maintenance therapy. In the low-dose group, the dose of Changtuoning was reduced by half. The cure rate, the recovery time of serum cholinesterase (CHE), the disappearance time of clinical symptoms and the changes of cardiopulmonary function and adverse reactions before and after the treatment were compared between the two groups. Results There was no significant difference in the cure rate, recovery time of CHE and disappearance time of clinical symptoms between the two groups (P > 0.05);five and seven days after the treatment, there was no significant difference in serum creatine kinase (CK), creatine kinase isoenzyme (CK-MB), left ventricular ejection fraction (LVEF), oxygen consumption (VO2), carbon dioxide production (VCO2) and ventilation volume per minute (VE) between the two groups (P > 0.05). The incidence of dry and restlessness of the low-dose group was significantly lower than that of the high-dose group (P < 0.05). Conclusion Low-dose Changtuoning can achieve the same effect as high-dose Changtuoning in the treatment of SAOPP poisoning patients with respiratory failure, with fewer adverse reactions and better safety.