长托宁与阿托品救治急性重度有机磷中毒的临床疗效

Therapeutic effect of penehyclidine hydrochloride and atropine on severe acute organophosphorus pesticide poisoning

目的对急性有机磷中毒的患者采用长托宁进行救治并观察临床疗效,探讨急性有机磷中毒的最佳治疗方案,为临床选择合适的治疗方法提供理论依据。方法回顾性分析长托宁和阿托品进行救治的急性有机磷中毒患者的资料,对两组患者的用药次数、阿托品化或长托宁化时间、并发症发生率、胆碱酯酶(Ch E)活性恢复70%时间、住院时间、住院费用、总有效率、病死率等进行观察,并进行统计学分析。结果阿托品组治疗有效率为92.47%(221/239),病死率为3.77%(9/239),并发症发生率为27.20%(65/239);长托宁组治疗有效率为96.59%(283/293),病死率为1.02%(3/293),并发症发生率为6.48%(19/293);长托宁组的治疗有效率显著高于阿托品组(χ~2=4.477,P<0.05),死亡率低于阿托品组(χ~2=4.489,P<0.05),并发症发生率低于阿托品组(χ~2=42.468,P<0.05)。与阿托品组比较,长托宁组的用药次数少,长托宁化时间、胆碱酯酶(Ch E)活性恢复70%时间和住院时间短,住院费用少,组间比较差异有统计学意义(P<0.05)。结论长托宁救治急性有机磷中毒,可以迅速缓解临床症状,减少并发症的发生,降低死亡率,临床疗效显著。

Objective To investigate the clinical efficacy of penehyclidine hydrochloride and atropine in treatment of acute organophosphorus pesticide poisoning( AOPP) so as to provide theoretical foundation for optimal treatment program of AOPP. Methods A retrospective study was done on the clinical data of patients with severe AOPP. The patients were divided into penehyclidine hydrochloride group and atropine group. The clinical efficacy was observed. The times of administration,time to atropinization,incidence of complications,time of recovery of cholinesterase( Ch E) activity to 70%,hospitalization time and cost,cure rate and mortality rate in two groups were observed and analyzed. Results In atropine group,the cure rate was 92. 47%( 221 /239),the mortality rate was 3. 77%( 9 /239) and the incidence of complications was 27. 20%( 65 /239). In penehyclidine hydrochloride group,the cure rate was 96. 59%( 283 /293),the mortality rate was 1. 02%( 3 /293) and the incidence of complications was 6. 48%( 19 /293). Compared with atropine group,penehyclidine hydrochloride group had a high cure rate( χ~2=4. 477,P = 0. 034),a low death rate( χ~2= 4. 489,P = 0. 034),and a low incidence of complications( χ~2=42. 468,P = 0. 000). Furthermore,penehyclidine hydrochloride group had reduced times of administration,shortened time to atropinization,rapid recovery of Ch E activity,short hospital stay,and low hospital expenses. The differences between two groups were statistically significant( P < 0. 05). Conclusions Penehyclidine hydrochloride can yield quick symptomatic remission,fewer complications and lower morbidity in the treatment of AOPP,with better clinical efficacy than atropine.