经皮和经口途径有机磷农药中毒后胆碱酯酶活性与中毒程度的不对等性比较

目的总结经皮和经口有机磷农药中毒的治疗经验。方法同期观察全血胆碱酯酶活性低于0．50的34例经皮途径（经皮组，中度19例，重度15例）和50例经口途径（经口组，中度22例，重度28例）有机磷农药中毒患者的临床表现，比较同等中毒程度时两组胆碱酯酶活性的变化以及阿托品用量的差异。结果同等中毒程度时，治疗前两组胆碱酯酶活性差异无显著性（P均〉0．05），但经皮组中毒症状明显轻于经口组。治疗后24、48和72h胆碱酯酶活性测定值经皮组明显高于经口组（P〈0．05或P〈0．01）。经皮组阿托品化用量及阿托品总量明显少于经口组，且解毒治疗时间也明显短于经口组（P均〈0．01）。结论胆碱酯酶活性相同情况下，经皮有机磷农药中毒患者的临床症状轻于经口有机磷农药中毒者，阿托品用量明显少于经口有机磷农药中毒者，胆碱酯酶活性的恢复经皮中毒患者先于经口有机磷农药中毒患者。

Cholinesterase activity is not parallel to symptoms in patients suffering from organophosphorous pesticide poisoning through skin or by gastrointestinal tract

OBJECTIVE: To sum up the experience of treating patients suffering from organophosphorous pesticide poisoning either through skin or through gastrointestinal tract. METHODS: The cholinesterase activity was less than 0.50 in all patients. They were divided into two groups: poisoning through skin (skin group) and by gastrointestinal route (gastrointestinal group). The number of poisoning through skin or gastrointestinal tract was 34 (19 cases of middle degree and 15 cases of severe degree) and 50 (22 cases of middle degree and 28 cases of severe degree), respectively. The blood cholinesterase activities were determined during the disease course, the clinical symptoms and signs were recorded, and the quantity of atropine used for treatment in respective group was also recorded. RESULTS: There were no difference in the cholinesterase activities at the same degree between two groups before treatment (P>0.05). But the symptoms of the patients in gastrointestinal group were more serious than in skin group. The cholinesterase activities of the patients in the skin group were higher significantly than that in the gastrointestinal group at 24, 48 and 72 hours after treatment (P<0.05 or P<0.01). The total amount of atropine to achieve atropinization was less in the skin group than that of the gastrointestinal group. The time for restoration of cholinesterase activity was shorter in skin group than the gastrointestinal group (both P<0.01). CONCLUSION: With the same level of enzymatic activity of cholinesterase, the symptoms of the patients poisoned via gastrointestinal tract are more serious than poisoning through skin, and the quantity of atropine is used very much more. Reactivation of the cholinesterase is earlier in patients poisoned by skin route.