“盐酸戊乙奎醚”与阿托品治疗急性有机磷农药中毒的临床观察比较

目的研究盐酸戊乙奎醚（长托宁）与阿托品治疗急性有机磷农药中毒的临床疗效和安全性比较。方法120例6小时内口服有机磷农药中毒者随机分成盐酸戊乙奎醚组（60例）和阿托品组（60例），均配伍用氯磷定，分别按照胆碱酯酶数值划分的轻中重度程度给予不同剂量的盐酸戊乙奎醚及阿托品，对两组患者的有效治愈率，死亡率，平均住院时间进行比较。结果盐酸戊乙奎醚组有效治愈率96．6％，死亡率3．4％，平均住院时间2．8d，阿托品组有效治愈率91．6％，死亡率8．4％，平均住院时间4．9d，两组比较有显著性差异（P〈0．01），且盐酸戊乙奎醚作用持续时间长，特别适用于毒理作用持续较长或中毒胆碱酯酶易老化的有机磷农药中毒，延长给药时间间隔，减少服药频度，减轻护士的工作强度．结论盐酸戊乙奎醚治疗急性有机磷农药中毒安全有效，疗效优于阿托品．     

42例急性有机磷中毒抢救的临床体会

目的总结急性有机磷中毒抢救的方法。方法对42例有机磷中毒患者进行持续微量泵泵入阿托品,严格观察使之阿托品化,防止出现阿托品过量以及阿托品中毒。结果 42例病例除5例死亡外,其余病例均经治疗后好转出院,治愈率88.10%。患者达到阿托品化的平均时间为(138.5±38.2)min,阿托品化需药量(78.3±6.8)mg。出现阿托品过量及中毒2例(4.76%),出现病情反跳3例(7.14%),出现中间综合征者2例(4.76%)。结论在急性有机磷中毒的抢救中使用持续微量泵入阿托品,可以降低达到阿托品化的需药量,并且可以降低出现阿托品过量及中毒的风险。     

Clinical correlates of hypotension in patients with acute organophosphorus poisoning

BACKGROUND:The aim of the present study is to describe the clinical correlates of hypotension and its associated outcomes in patients with acute organophosphorus poisoning(AOPP).METHODS:In this retrospective cohort study,we analyzed data pertaining to 871 patients with AOPP who were treated at two hospitals.Data from hypotensive and non-hypotensive patients were compared to identify clinical correlates of hypotension.We also evaluated the association between clinical parameters(including hypotension)and in-hospital mortality.RESULTS:The incidence of hypotension in AOPP patients was 16.4%.Hypotensive patients showed signifi cantly higher in-hospital mortality(1.1%vs.39.9%,P<0.001).Advanced age(odds ratio[OR]1.25,95%confi dence interval[CI]1.08–1.44),history of diabetes(OR 2.65,95%CI 1.14–5.96),and increased white blood cell count(OR 1.06,95%CI 1.03–1.09),plasma cholinesterase(OR 0.91,95%CI 0.84–0.94),plasma albumin(OR 0.88,95%CI 0.85–0.92),serum amylase(OR 1.01,95%CI 1.01–1.02),and blood pH(OR 0.64,95%CI 0.54–0.75)were signifi cantly associated with hypotension.After adjusting for potential confounders,hypotension was associated with increased in-hospital mortality(hazard ratio 8.77–37.06,depending on the controlled variables).CONCLUSIONS:Hypotension is a common complication of AOPP and is associated with increased in-hospital mortality.Advanced age,history of diabetes,and changes in laboratory parameters were associated with hypotension in AOPP patients.     

急性有机磷中毒的急诊急救护理

目的探讨急性有机磷中毒急诊急救的综合护理,寻求提高抢救成功的对策,降低死亡率。方法对本院急诊科2002年1月至2007年3月收治的92例急性有机磷中毒患者的临床资料进行回顾分析,对中毒途径、中毒程序、服药量、中毒至就诊时间及各种处理措施等因素进行分析。结果早期彻底洗胃,合理维持阿托品化和应用呼吸机是有效的处理措施。全组治愈87例（94．6％）,死亡5例（5．4％）。呼吸循环衰竭、阿托品中毒为主要死亡原因。结论有效的护理措施、预防并及时处理并发症和辅助方法的恰当选用是提高存活率的关键。     

有机磷农药中毒病人洗胃方法的探讨

[目的]提高有机磷农药中毒病人抢救成功率。[方法]把169例急性有机磷农药中毒病人按来诊先后随机分组,采用不同洗胃方法进行洗胃并时效果比较分析。[结果]左侧卧位插胃管洗胃、延长胃管插入长度洗胃与低压少量洗胃液洗胃在插胃管、洗胃时间、洗胃效果方面明显优于对照组,有统计学意义。[结论]采用左侧卧位插胃管、延长胃管插入长度至55cm～70cm、低压少量洗胃液反复洗胃,可提高有机磷农药中毒抢救成功率。     

血清PCT对急诊有机磷中毒患者感染的监测价值

目的探讨血清降钙素原(PCT)在急诊有机磷中毒患者感染中的监测价值及评估感染与预后情况的应用价值。方法选取2013年3月至2015年3月本院收治的急性有机磷中毒患者316例,按患者血培养、中段尿培养、腹腔引流液及痰培养结果划分感染组及非感染组。患者入院后采静脉血检测PCT,PCT定采用快速半定量免疫色谱法(德国BRAHAMS公司生产的快速半定量免疫色谱试剂盒),将PCT测量结果分为4级:0.5ng/mL,0.5~2μg/mL,2~10ng/mL,≥10μg/mL,以不低于0.5μg/mL为阳性阈值。对患者入院24h内的可疑感染部位作为检测标本(使用美国BD公司生产的BACTEC9120全自动培养仪进行细菌培养),进行血培养、中段尿培养、腹腔引流液及痰培养。结果 316例患者中发生感染136例,未发生感染180例,其感染率为43.04%;136例感染患者的细菌培养阳性53例,阳性率为38.98%;53例中包括41例革兰阴性菌感染、8例革兰阳性菌感染及4例两种菌同时感染。感染组的PCT水平不低于0.5ng/mL的有130例,而非感染组仅31例,感染组的PCT水平明显高于非感染组,差异有统计学意义(P0.05)。316例患者中感染组136例,其阳性阈值130例,而非感染组180例中不属于阳性阈值的149例。其阳性预测值为80.75%,阴性预测值为96.13%,灵敏度为95.59%,特异度为82.78%。经过抗菌药物的治疗,存在感染呈现阳性的急性有机磷中毒患者的血清PCT水平在4~7d内逐渐降低并小于0.5ng/mL,临床的感染症状得以控制。结论血清PCT测定对急诊有机磷中毒患者感染期的监测有指导意义,可以评估有机磷中毒的感染状况和预后情况,并指导其用药。     

大黄对有农药中毒并发胃肠功能衰竭的研究

目的：研究大黄对有机磷农药中毒（ＡＯＰＰ）合并胃肠功能衰竭的治疗作用。方法：采用昆明种小白鼠进行动物实验,分为２ 个治疗组及中毒组,观察小鼠中毒出现的时间和死亡时间。临床观察２６４例ＡＯＰＰ患者,其中２０４ 例作为治疗研究,６０例作为对照研究,观察大黄对出血胃粘膜止血和恢复胃肠蠕动的疗效。结果：动物实验２ 个治疗组与中毒组间中毒出现时间均有显著性差异〔（５．４±０．７）ｍ ｉｎ、（４．９±０．３）ｍ ｉｎ 比（１．２±０．３）ｍ ｉｎ,Ｐ 均＜ ０．０１〕;３ 组间死亡时间比较差异也极显著〔（４８．６±７．５）ｍ ｉｎ、（４２．７±０．６）ｍ ｉｎ 比（７．５±１．２）ｍ ｉｎ,Ｐ均＜ ０．０１〕。临床观察治疗组与对照组间缓解腹胀、恢复胃肠蠕动有显著性差异（Ｐ＜ ０．０５）,止血及预防再出血有显著性差异（Ｐ＜ ０．０５）。结论：ＡＯＰＰ时在内科综合治疗情况下采用口服大黄,能有效地防治ＡＯＰＰ并发胃肠功能衰竭,恢复胃肠蠕动,并可以改变中毒的自然演变过程。     

The comparison of therapeutic effects of atropine and pralidoxime on cardiac signs in rats with experimental organophosphate poisoning

Organophosphate poisoning causes disturbances in cardiac conduction and potentially fatal severe cardiac rhythm abnormalities. This study investigated the cardiac effects of atropine and pralidoxime in the treatment of organophosphate poisoning in rats. Three groups of 10 adult male Wistar rats were anesthetized with an intraperitoneal injection of ketamine 100 mg/kg and xylazine 10mg/kg and connected to a computerized electrocardiographic monitor. Each rat was then injected intraperitoneally with the pesticide dichlorvos 70 mg/kg. Sixty seconds after the injection, 10 rats were injected with saline, 10 with pralidoxime mesylate 20 mg/kg, and 10 with atropine 10 mg/kg. During the computerized electrocardiographic monitoring, each rat’s heart rate and QT_c intervals were recorded and analyzed as the injections were administered. The heart rates in all 3 groups did not differ before the dichlorvos was administered, nor at 60 seconds afterward, but in the atropine group, the time elapsed before the first decline in heart rate was significantly longer than that in the control group (P< .05). In addition, the interval before death was significantly longer in the atropine group than in either the control group or the pralidoxime group (P< .05 for both). The QT_c was almost identical in each of the groups. Atropine has beneficial effects on the heart rate, prolongs the time before the heart rate declines, and delays death but has no effect on the QT_c interval. Further research about the toxic effects of organophosphate compounds on myocardial cells is warranted.     

长托宁联合血液灌流在重度有机磷中毒救治中的疗效分析

目的探讨长托宁联合血液灌流救治重度有机磷中毒的治疗效果。方法选择2010年1月至2013年4月,重复应用长托宁、氯解磷定结合血液灌流的46例患者为治疗组;选择2008年1月至2009年12月重复应用阿托品、氯解磷定的21例患者为对照组,观察两组患者24h血清胆碱酯酶（CHE）水平、CHE恢复时间、治愈率及中间期肌无力综合征、肺部感染、呼吸衰竭等并发症情况。结果治疗组入院后24h血CHE水平降低（P〈0．05）,CHE恢复时间缩短（P〈0．05）,治愈率提高（P〈0．05）,中间期肌无力综合征、肺部感染、呼吸衰竭等并发症明显减少（P〈0．01或〈0．05）。结论应用长托宁联合血液灌流救治重度有机磷中毒,效果显著,值得推广应用。     

急性有机磷中毒患者不同心电图改变对其预后预测价值的研究

目的 研究急性有机磷中毒患者不同心电图改变及对其预后的预测价值.方法 入选河南省人民医院103例急性口服有机磷中毒患者,入院时及入院24 h分别行心电图检查,对比两次心电图变化特征,应用统计学方法分析不同心电图变化对其预后的预测价值.结果 对入选的103例急性有机磷中毒患者临床资料进行分析发现,PR间期与急性呼吸衰竭发生率之间比较差异有统计学意义,年龄和QTc间期与死亡及急性呼吸衰竭发生率差异均有统计学意义.入院24 h后QTc均较入院时延长.血胆碱酯酶(CHE)、QTc和两次QTc之差(△QTc)对急性呼吸衰竭发生率受试者工作特征曲线(ROC)下面积分别为:0.033 (95％ CI:0.004～0.063),0.829(95％CI:0.739 ～0.918)和0.943 (95％ CI:0.888 ～0.998);CHE、QTc和△QTc对病死率ROC曲线下面积分别为:0.052(95％ CI:0.01 ～0.094),0.693 (95％ CI:0.559 ～0.826)和0.895 (95％ CI:0.814～0.977).结论 △QTc可能作为新的、更好的预测急性口服有机磷中毒患者短期预后的指标.     

重度有机磷农药中毒救治中需重视的环节及护理

介绍了重度有机磷农药中毒病人救治中需要重视的环节及应采取的护理措施,认为快速、彻底清除机体内毒物并主动配合医生实施准确救护是关键。     

活性炭吸附联合导泻救治急性有机磷中毒的疗效研究

目的:探讨活性炭吸附联合导泻对急性有机磷中毒的临床疗效。方法:选择50例重度急性有机磷中毒患者随机分为两组各25例。对照组采用传统治疗方法;实验组采用传统治疗方法加活性炭悬液胃肠道反复灌洗,灌洗后导泻。观察两组患者服毒至开始抢救时间、入院时胆碱酯酶活力、反跳发生病例数、呼吸衰竭发生病例数、中间综合征(IMS)发生病例数、死亡病例数;观察两组中存活病例达阿托品化的时间、达阿托品化所需的阿托品用量、入院至痊愈阿托品用药总量及住院时间。结果:实验组达阿托品化所需的时间及住院时间均短,差别有高度显著性意义(P<0.01);反跳发生病例数少,达阿托品化所需的阿托品量及入院至痊愈阿托品用药总量也较对照组少,差别有显著性意义(P<0.05)。结论:活性炭吸附联合导泻可明显缩短急性有机磷中毒患者达阿托品化的时间,减少阿托品用量,降低反跳的发生率并显著缩短住院时间。     

Electrocardiographic findings of acute organophosphate poisoning

In this study, we evaluated 85 patients who presented to our Emergency Department with organophosphate (OP) poisoning and discuss their associated electrocardiographic (ECG) abnormalities. Over a period of 3 years, 85 patients with OP poisoning were included in this retrospective study. ECG analysis included the rate, rhythm, ST-T abnormalities, conduction defects, and measurement of PR and QT intervals. The mean age was 32.2 +/- 14.9 years. Sixty percent of the patients were female. The mean corrected QT interval (QTc interval) was 0.435 +/- 0.052 s. Prolongation of the QTc interval (55.5%) was the most common ECG abnormality, followed by sinus tachycardia (31.8%). Elevation of the ST segment and low amplitude T waves were seen in 15 cases (17.6%). Patients with OP poisoning might reveal ECG abnormalities such as QTc interval prolongation or non-specific ST-T changes. QTc interval prolongation cannot be used as a unique predictive factor in determining short-term prognosis in OP poisoning. We found no clear relation between OP poisoning-related malignant ventricular dysrhythmia and QTc interval.     

血液灌流对急性重度有机磷中毒的疗效评价

目的 评价血液灌流治疗急性重度有机磷中毒的疗效.方法 选取1999-2007年间收住我院经洗胃、阿托品、氯磷定、抗感染及呼吸支持等综合治疗且临床资料完整的急性重度有机磷中毒患者71例,其中经血液灌流治疗35例,未经血液灌流治疗36例,对照分析两组患者临床效果.结果 血液灌流组患者灌流后血CHE水平显著回升(P<0.01),血WBC、PLT和Cr明显下降(P<0.01或P<0.05),血PT明显延长(P<0.05).与非血液灌流组比较,血液灌流组患者入院24 h后血CHE水平明显回升(P<0.05),阿托品总用量、呼吸机使用时间、住院时间均明显下降(P<0.05),并发症(中间期肌无力综合征、肺部感染、呼吸衰竭等)明显减少(P<0.01或P<0.05),治愈率明显提高(P<0.05),而住院费用无明显变化(P>0.05).结论 对急性重度有机磷中毒患者在综合治疗基础上加用血液灌流,治疗效果显著,值得在急诊科进一步推广应用.     

重度有机磷农药中毒救治中需重视的环节及护理

介绍了重度有机磷农药中毒病人救治中需要重视的环节及应采取的护理措施,认为快速、彻底清除机体内毒物并主动配合医生实施准确救护是关键。     

重度有机磷农药中毒78例临床分析

目的：探讨重度有机磷农药中毒的救治方法。方法：回顾性分析重度有机磷农药中毒78例的临床资料。结果：78例中痊愈71例,死亡7例。结论：早期、及时、足量阿托品,尽早阿托品化,仔细观察,呼吸衰竭者及时使用呼吸机可提高存活率。     

改良应用解毒药物治疗有机磷中毒时的病情观察

目的 探讨改良应用解毒药物治疗有机磷中毒时的病情观察方法,以提高治愈率.方法 观察组患者426例采用新方法治疗,即使用阿托品快速消除中毒症状后停药观察,待再出现轻微中毒症状时再次应用阿托品,氯磷定仅应用1～2d;对照组患者470例采用传统治疗方法,即达到传统阿托品化标准后维持一段时间,逐渐减量,直至停用阿托品.收集两组氯磷定和阿托品应用时间、应用总量、住院天数和不良反应等资料,并对两组资料进行统计学分析.结果 观察组几乎无尿潴留、烦躁不安和呼吸衰竭等不良反应的发生,解毒药物的应用时间及总量亦明显少于对照组,大部分患者24 h即可不再应用解毒药物且经观察无反跳病例发生.结论 认真观察病情变化、及时合理调整解毒药物的应用,能明显提高治愈率、缩短住院时间、减少过量应用阿托品及氯磷定造成的毒副反应.     

Clinical profile and outcome of patients hospitalized with dimethyl and diethyl organophosphate poisoning

The two major classes of organophosphate compounds, dimethyl and diethyl organophosphates, have different toxicokinetic properties. This study evaluated the clinical profile and outcomes in patients admitted with poisoning with these two classes of organophosphates. Methods.?This retrospective study spanned 6 years (2002–2007). Patients were treated with atropine and supportive care including ventilation, as required, and followed up until death or hospital discharge. Oximes were not administered. Of the 422 charts retrieved, 396 fulfilled inclusion criteria. Data on the clinical profile, ventilation, length of hospital stay, incidence of intermediate syndrome and mortality were extracted. Results.?The mean (±standard deviation) age was 31.4?±?12.7 years with a male preponderance (2.6:1). The median (interquartile range (IQR)) admission pseudocholinesterase level of 317 (222–635) U/L indicated significant inhibition of cholinesterase activity. The median lag-time to presentation to our hospital was 5 (IQR 3–8.5) hours. Oximes were administered at a primary center in 33 patients (8.3%). Dimethyl organophosphate was ingested by 141 patients, diethyl organophosphate by 108, S-alkyl organophosphate by 2, and an un-identified organophosphate by 145 patients. Ventilation was required in 260 patients (65.7%); the median duration of ventilation being 7.5 (IQR 3–12) days. Overall mortality was 13.1%. There was a significant difference between dimethyl and diethyl organophosphate compounds in ventilatory requirement (76% vs. 56%, adjusted odds ratio (OR) 2.37, 95% CI 1.01–5.57, p?=?0.047), duration of ventilation (11 (4–15) vs. 5 (2–9) days, adjusted OR 1.12, 95%CI 1.04–1.21, p?=?0.002) and incidence of intermediate syndrome (72/125 (58%) vs. 24/92 (26%), adjusted OR 2.84, 95%CI 1.38–5.86, p?=?0.004). Mortality was similar in the two groups (20/141 (14%) vs. 7/108 (6%), dimethyl vs. diethyl organophosphate, adjusted OR 1.29, 95%CI 0.43–3.94, p?=?0.65). Conclusions.?Patients admitted with dimethyl organophosphate poisoning have a worse outcome compared with diethyl organophosphate poisoning for clinically relevant patient outcomes.     

三七总皂甙对急性有机磷农药中毒脏器损伤的保护作用研究

目的：研究三七总皂甙对急性有机磷农药中毒脏器损伤的保护作用及其机制。方法;健康日本大耳兔２４只,随机分为３组,每组８只,正常对照组（Ａ组）输入与其它２组等量（４０ｍｌ）的生理盐水;急性有机磷农药中毒组（Ｂ组）胃管灌入敌敌畏乳剂１６ｍｇ／ｋｇ;三七总皂甙保护组（Ｃ组）和灌入敌敌畏前３０分钟静脉给予三七总皂甙１００ｍｇ／ｋｇ,观察３组动物血清天冬氨酸转氨酶（ＡＳＴ）、丙氨酸转氨酶（ＡＬＴ）、乳酸脱氢酶