辛硫磷农药中毒患者血清胆碱酯酶恢复延迟的临床研究及探讨

目的研究辛硫磷农药中毒患者病情变化与血清胆碱酯酶（ChE）恢复的关系。方法95例重度有机磷中毒（AOPP）患者，包括A组辛硫磷中毒患者45例，B组其他有机磷中毒患者50例，入院后均给予洗胃、清除毒物、解磷定、阿托品及积极的对症支持治疗。分别于入院时、治疗后1、2、3、4、5、6～8、8～11、11～13天……及出院时抽血测定血清ChE，计算阿托品用量。结果血清ChE在两组患者治疗前无统计学意义（P〉0．05），治疗后1—3天部分有下降趋势，第1天降至最低，3天后B组血清ClE逐渐上升，而A组ChE持续低水平。6—9天后缓慢回升，部分患者出院时仍低于甚至明显低于正常，但两组预后无显著差异．A组胆碱酯酶恢复时间13—44天，较B组7—25天明显延迟。阿托品用量大，治疗时间长。结论辛硫磷中毒患者ChE恢复明显延迟．对AOPP患者合理治疗具有重要指导意义。

Clinical Research on the Recovery Delay of Serum Cholinesterase in Patients with Phoxim Pesticide Poisoning

Objective To study the relationship between variation of illness change and serum cholinesterase （ChE） recovery in patients with phoxim pesticide poisoning. Methods 95 patients with severe acute organic phosphorus poisoning （AOPP） including 45 cases of phoxim poisoning （group A）, and 50 cases of other organophosphate poisoning （group B） were given gastric lavage, removing toxins, phosphate-solubilizing, atropine, and active support therapy. The serum ChE before therapy and at the time of 1, 2, 3, 4, 5, 6 - 8, 8 - 11, 11 13 days after therapy was detected and the dosage of atropine was calculated. Results Serum ChE before therapy was similar in two groups （P 〉0.05）, partially declined at 1 - 3 days after therapy and decreased to the lowest level at the time of 1 d, serum ChE in group B gradually raised after 3 days, but serum ChE in group A continued low and gradually raised at the time of 6 - 9 d, it was abnormal or even significantly until discharge, but the prognosis had no significant difference, cholinesterase recovery time in group A （13 - 44 d） significantly delayed compared with group B （7 - 25 d）, and higher dosage of atropine, longer time of treatment. Conclusions The ChE recovery significantly delays with phoxim poisoning patients; it has directive value in rational therapy of AOPP patients.