急性有机磷农药中毒并呼吸衰竭机械通气患者洗胃方法的探讨

Evaluation of gastric lavage treatment for severe acute organophosphorus pesticides poisoning complicated by respiratory failure requiring mechanical ventilation

目的 探讨急性有机磷农药中毒 (AOPP)并呼吸衰竭机械通气患者的洗胃方法。方法对 92例AOPP并呼吸衰竭机械通气患者分别采用切开洗胃及鼻胃管洗胃 ,每种洗胃方式又分空腹组和餐后组。结果 采用胃管洗胃时空腹组昏迷时间、阿托品化时间和用量、阿托品总量、机械通气时间、胆碱酯酶恢复至正常 5 0 %的时间、住院时间、费用、反跳率、阿托品中毒发生率及病死率为 13(3～2 4 )h、180 (6 0～ 2 90 )min、15 0 (80～ 310 )mg、30 0 (90～ 870 )mg、17(4～ 5 2 )h、(5 0± 2 3)d、9(7～ 18)d、(80 80± 2 5 70 )元、0、0、4 76 % ,明显优于餐后组 2 6 (4～ 5 5 )h、380 (110～ 6 90 )min、36 0 (90～ 730 )mg、36 10(110 0～ 90 70 )mg、36 (6～ 110 )h、(7 8± 3 6 )d、12 (9～ 35 )d、(10 72 0± 335 0 )元、4 5 %、30 %、30 0 0 % (P值均 <0 0 1或 0 0 5 ) ;而采用切开洗胃时空腹组与餐后组两组比较差异无显著意义 (P >0 0 5 )。空腹中毒者采用切开或胃管洗胃除前者费用 (12 4 70± 4 72 0 )元高于后者 (80 80± 2 5 70 )元 (P <0 0 1)外 ,疗效、并发症及病死率差异均无显著意义 (P >0 0 5 ) ;餐后中毒者采用切开洗胃明显优于胃管洗胃 (P值均≤ 0 0 1或 0 0 5 ) ,且费用相当 (P >

Objective To discuss the measures of gastric lavage for severe acute organophosphorus pesticides poison (AOPP) patients complicated with respiratory failure and treated with mechanical ventilation. Methods 92 cases of respiratory failure due to severe AOPP treated with mechanical ventilation were treated for gastric lavage with nasal gastric tube or gastrotomy .Patients of each gastric lavage method were divided into fasting toxicosis group (fasting group) and post-meal toxicosis group (post-meal group). Results When treated for lavage with nasal gastric tube,the duration of coma,the time for reaching atropinization and the dosage of atropine needed,the total dosage of atropine used,the mechanical ventilation time,the time for restoring 50% of the normal value of choline esterase,the hospitalization time and charges,the relapse rate,the rate of atropine toxicosis and mortality were respectively: 13(3-24)h,180(60-290)min,150(80-310)mg,300(90-870)mg,17(4-52)h,(5.0±2.3) d,9(7-18)d,(8080±2570) yuans ,0,0,and 4.76% in the fasting groups;all the figures were superior to those of the post-meal group with the same treatment: 26(4-55)h,380(110-690)min,360(90-730)mg,3610(1100-9070)mg,36(6-110)h,(7.8±3.6) d,12(9-35)d,(10 720±3350) yuans,45%,30%,and 30.00% ( P <0.01 or P <0.05). There was no obvious difference between the fasting group and the post-meal group in curative effect,complication occurrence rate and mortality except for the charges when treated with gastrotomy. For the post-meal toxicosis patients gastrotomy showed a better effect than the nasal gastric tube and there was no difference in charges. Conclusions It is suggested that severe AOPP patients complicated with respiratory failure and treated with mechanical ventilation should hare lavage with nasal gastric tube,if they were poisoned in fasting state ,but they should be washed through gastrotomy if poisoned after meal.