急性有机磷农药中毒迟发性周围神经病36例临床分析

Delayed polyneuropathy after Acute Organophosphorus Pesticides Poisoning: Clinical Analysis of 36 Cases

目的 探讨急性有机磷农药中毒迟发性周围神经病的临床特点。方法 对急性有机磷农药中毒迟发性周围神经病 36例患者进行临床分析。结果 OPIDP的发生率为同期入院的急性有机磷农药中毒患者人数的 5 % ,患者均为口服重度中毒者 ,潜伏期平均 2 1天 ,病程平均 (12 .1± 6 .1)个月。首发症状为自四肢远端开始的感觉异常 ,感觉和运动障碍 ,患者出现肢体麻木、乏力、腕下垂、足下垂、腱反射减弱或消失、肌萎缩等 ,神经 -肌电图显示神经源性损害改变 ,神经 -肌电图异常程度与患者周围神经损害症状体征的严重程度相平行。用B族维生素、强的松、理疗和针灸治疗后全部病例完全康复。结论 此病以多发性周围神经病为主要表现 ,根据口服有机磷农药中毒史 ,临床症状和体征以及神经 -肌电图神经源性损害可以作出诊断 。

Objective To explore the clinical characteristics of delayed polyneuropathy after acute organopyhosphorus (OP) pesticides poisoning.Methods Clinical analysis were made in 36 cases with organophsphate induced delayed polyneuropathy (OPIDP). Results The occurrence rate of OPIDP was 5% among total in-patients of acute OP poisoning during the same period. Au the OPIDP cases were severely oral poisoning. The average incubation of the 36 cases was 21 days. The average Course of the disease was (12.1±6.1) months. The initial symptoms were ascending abnormal sensation. Sensory loss and dyskinesia began from distant parts of the limbs. The patient had reduction or disappearance of tendon reflexes, weakness, carpoptoses, footdrop and muscle atrophy in limbs. Electromyography showed a neurogenic lesion pattern, which was paralled to the clinical symptoms and signs. All the 36 cases totally recovered after treatment with Vitamin B Co, prednisone, physical therapy, acupuncture and moxibustion, Conclusions The main manifestation of the disease is multiple peripheral neuropathy. Diagnosis should be made according to the history of oral OP poisoning, the typical clinical manifestations of peripheral neuropathy and the neurogenic lesion changes on electromyography. The prognosis has better effect generally.