杀虫双与有机磷等混配农药急性中毒的临床治疗初步探讨

Clinical Study on Therapy of Acute Poisoning of Bisultap Combined with Organophosphorous or other Pesti-cides

[目的]探讨肟类药物对沙蚕毒系类农药与有机磷杀虫剂 (OP)、氨基甲酸酯农药 (CB)混配中毒的疗效。[方法]对收治的急性单纯杀虫双 (单 )及其与OP、CB等其他农药混配中毒的患者12例进行临床观察、实验室检查[包括全血胆碱酯酶 (ChE)活力测定]及治疗。患者入院后彻底清洗污染的皮肤或洗胃 ,并给予阿托品 (At)和肟类药物治疗及对症治疗。根据病情轻重 ,At首剂用量1～10mg,总量10～176mg ,7例用肟类药物碘解磷定2～4g,5例用氯解磷定3～10g。[结果]所有患者治疗后急性胆碱能兴奋或危象的症状和体征逐渐减轻或消失 ,用肟类药物未见明显的不良反应 ,2例中度中毒患者在氯解磷定治疗6h后肌束震颤消失。绝大多数患者全血胆碱酯酶恢复到正常或接近水平 (46 %～95 % )。全部患者住院2～6d ,痊愈出院。[结论]急性杀虫双与OP或CB混配中毒 ,可足量使用At并酌情使用肟类ChE复能剂治疗 ,疗效较好 。

To clarify whether pralidoxime therapy is effective in acute poisoning of bisultap with organophosphate(OP)or carbamate(CB).After exposure history of pesticides was taken,physical examination,clinical observation and treatˉment were carried out in12cases of acute poisoning of bisultap combined with organophsphate(OP),carbamate(CB)or other pestiˉcides.The whole blood ChEactivities were determined.All patients received atropine and oxime treatmentas well as thoroughdecontaminaˉtion of skin and gastric lavage.The initial and total atrpine dose was1～10mg or10～176mg,respectively,according to the severity of intoxication.7patients were given2～4g of pralidoxime iodide,5other patients treated with3～10g of pralidoxime chloride. All patients recovered from acute cholinergic excitation or crisis after treatment.No obvious adverse effects were seen with pralidoxime therapy.The muscle fasciculation in2cases of moderate poisoning disappeared within6hours after administration of oxime.Inhibited ChE activity was reactivated to almost normal level(46%～95%)in most cases.All patients were discharged fromthe hospital2～6days after.[Conclusion]Pralidoxime is effective against cholinergic excitation and nicotinic effects,and can be used as therapeutic drugs with atropine in the treatment of acute combined pesticides poisoning of bisultap combined with OP or CB.