机械通气抢救急性有机磷农药中毒呼吸衰竭47例

目的探讨机械通气治疗重度有机磷农药中毒呼吸衰竭的临床意义。方法重度有机磷农药中毒呼吸衰竭患者患者83例,按是否机械通气分为治疗组47例和对照组36例。两组均常规给予洗胃、应用阿托品、氯磷定及对症支持治疗等综合措施,治疗组给予机械通气。结果治疗组抢救成功率（89％）明显高于对照组（69％）（P〈0．05）。结论早期建立人工气道机械通气是有机磷农药中毒并呼吸衰竭抢救成功的关键。     

呼吸机应用救治重度有机磷农药中毒呼吸衰竭体会

目的介绍治疗重度有机磷农药中毒呼吸衰竭的体会。方法对25例急性有机磷农药中毒（AOPP）呼吸衰竭患者,应用机械通气等综合治疗。结果抢救成功23例,死亡2例。结论早期应用机械通气呼吸支持,救治有机磷农药中毒呼吸衰竭患者,能够提高抢救成功率。     

急性重度有机磷农药中毒50例救治体会

目的：探讨急性重度有机磷农药中毒（AOPP）的诊治方法。方法：对50例AOPP的临床资料进行回顾性分析。结果：50例AOPP患者中,5例因就诊时间过晚,未进行抢救已死亡;1例于服毒30h出现中间综合征（INS）,出现呼吸肌麻痹、呼吸衰竭死亡;44例经彻底洗胃、应用阿托品、碘解磷定,建立人工气道,使用呼吸机等抢救治愈。结论：AOPP在急性中毒中常见,早期诊断、早期应用阿托品、碘解磷定,早期强化行血液灌流是抢救成功的关键。     

机械通气在重度有机磷农药中毒所致呼吸衰竭中的应用

目的观察机械通气在急性有机磷农药中毒所致呼吸衰竭中的作用。方法对本院收治的重度有机磷农药中毒并发呼吸衰竭实施机械通气11例患者进行临床分析。结果呼吸衰竭抢救成功9例(81.82%),机械通气前后血气分析相差具有显著性。结论机械通气是治疗急性有机磷农药中毒所致呼吸衰竭的关键环节。     

急性重度有机磷农药中毒合并呼吸衰竭的救治体会

目的探讨急性有机磷农药中毒合并呼吸衰竭的救治方法。方法对42例急性重度有机磷农药中毒合并呼吸衰竭的病人进行彻底洗胃、应用特效解毒剂及胆碱酯酶复活剂、机械通气、血液灌流等措施,成功抢救39例中毒病人,,死亡3例。结论急性重度有机磷农药中毒合并呼吸衰竭病情险恶、并发症多、死亡率高,如不及时抢救,预后极差。     

机械通气抢救有机磷农药中毒并发呼吸衰竭28例体会

目的 探讨机械通气抢救急性有机磷中毒并发呼吸衰竭的方法及其疗效.方法 回顾总结28例急性有机磷农药中毒并发呼吸衰竭机械通气的抢救经验.结果 28例急性有机磷农药中毒并发呼吸衰竭机械通气患者抢救成功率96.4％.结论 机械通气可有效提高重度有机磷农药中毒的抢救成功率.     

机械通气联合血液灌流抢救重度有机磷中毒的护理体会

目的：总结机械通气联合血液灌流抢救重度有机磷中毒的护理体会。方法10例重度急性有机磷中毒合并呼吸衰竭患者,迅速清除毒物包括清洗皮肤、毛发,催吐、洗胃、导泻,及早使用长托宁、氯解磷定,及早行气管插管、呼吸机支持,及早行血液灌流等综合治疗,同时予以生命体征监测、人工气道及呼吸机管理、血液灌流管理、饮食及心理护理。结果10例患者均痊愈出院,无1例发生呼吸机相关性肺炎。结论机械通气能有效改善患者通气,纠正呼吸衰竭;血液灌流能及早清除进入血液中的毒物,提高救治成功率。     

机械通气救治有机磷农药中毒中间综合征36例临床分析

目的观察机械通气在救治急性有机磷农药中毒中间综合征中的作用。方法对本院救治的重度有机磷农药中毒中间综合征实施人工通气的36例患者进行临床分析。结果所有患者均有明显急性胆碱能象和呼吸肌麻痹,经抢救后治愈33例（92%）。死亡3例（8%）,死亡原因为并发严重肺感染和多脏器功能衰竭。结论中间综合征病程有自限性特点,早建立人工气道、机械通气支持是抢救成功的关键。     

呼吸机在重度有机磷农药中毒中的应用

目的 探讨呼吸机在重度有机磷农药中毒中的应用.方法 对我院收治的5例重度有机磷农药中毒患者入院后给予清水洗胃,给气管插管,呼吸机辅助呼吸,同时给胆碱酯酶复能剂,给阿托品首剂即给阿托品化.结果 5例患者经以上治疗后,4例痊愈,死亡1例.结论 有机磷农药中毒呼吸衰竭患者,应及时建立人工通气并正确使用呼吸机辅助通气,监测好患者生命征,合理应用阿托品,解磷定等治疗,才能提高抢救成功率.     

机械通气在重度有机磷中毒呼吸衰竭中的作用

目的探讨机械通气在治疗重度有机磷中毒所致呼吸衰竭中的作用。方法对30例重度有机磷农药中毒所致呼吸衰竭患者,在其他治疗的基础上采用机械通气进行辅助治疗。结果30例患者,抢救成功27例,死亡3例。机械通气前后患者的血气指标差异有统计学差异(P<0.05)。结论机械通气对治疗重度有机磷农药中毒所致呼吸衰竭起到重要作用。     

甲氯酚酯治疗儿童急性重度有机磷中毒疗效观察

目的：探讨甲氯酚酯用于儿童急性有机磷农药中毒的临床治疗效果。方法：将近10年我科收治的急性有机磷农药中毒患儿58例,随机分为治疗组30例（女10例）,对照组28例（女9例）,对照组采用洗胃、静脉推注阿托品、解磷定、吸氧、保持呼吸道通畅等常规方法。治疗组在常规治疗的基础上静脉滴注甲氯酚酯（剂量60～100mg/次,2次,d）观察两组儿童的治疗效果。结果：治疗组治愈26例,治愈率86．7％;对照组治愈19例,治愈率67．9％两组比较P〈O．05。结论：在抢救重度有机磷农药中毒时,及时应用甲氯酚酯能明显提高抢救成功率,值得临床推广使用。     

血液灌流治疗有机磷中毒的临床研究

目的：探讨血液灌流治疗急性有机磷农药中毒的临床疗效。方法：75例有机磷农药中毒患者,按入院后接受血液灌流（HP）或未接受血液灌流分为灌注组（HP组）38例和非灌注组（非HP组）37例,中毒患者送入本院后均按常规给予洗胃,及阿托品、解磷定治疗和对症支持治疗,HP组加用血液灌流治疗,观察两组患者治愈率、阿托品用量、意识恢复情况、胆碱酯酶活力和中间综合征（IMS）发生率情况。结果：HP组38例全部治愈,发生IMS1例。对照组37例治愈32例,治愈率为86.5%,其中5例死于呼吸衰竭,其中发生中间综合征5例。两组间意识恢复时间、阿托品所需总量、胆碱酯酶恢复时间比较,差异有统计学意义（P〈0.05）。结论：血液灌流治疗急性有机磷农药中毒的临床疗效显著,可促进患者的意识恢复、减少阿托品的总用量、提高治愈率,值得临床推广应用。     

综合措施救治重度急性有机磷农药中毒伴呼吸衰竭28例

目的探讨救治重度急性有机磷农药中毒伴呼吸衰竭的有效措施。方法对28例重度急性有机磷农药中毒伴呼吸衰竭的患者,给予紧急气管插管、机械通气,迅速阿托品化,早期、足量氯磷定,尽早、反复、彻底洗胃,大量纳洛酮．以及对症治疗和支持治疗等。结果28例重度急性有机磷农药中毒伴呼吸衰竭患者中,治愈出院24例（85．7％）,死亡4例（14.3％）。结论综合措施治疗,可减少重度急性有机磷农药中毒伴呼吸衰竭的死亡率。     

机械通气治疗急性重度有机磷中毒致呼吸衰竭患者撤机方法探讨

目的 探讨机械通气治疗急性重度有机磷农药中毒致急性呼吸衰竭中毒患者的撤机方法.方法 回顾性分析51例使用机械通气抢救急性重度有机磷农药中毒致呼吸衰竭患者的临床资料和撤机情况.结果 51例患者治愈45例,抢救成功率88.2％,死亡6例,病死率11.8％.结论 尽早使用呼吸机抢救并择机撤机直接影响到患者的生活质量和改善预后、降低病死率.     

Acute soman poisoning in primates neither pretreated nor receiving immediate therapy: value of gacyclidine (GK-11) in delayed medical support

Organophosphorus (OP) nerve agents are still used as warfare and terrorism compounds. Classical delayed treatment of victims of organophosphate poisoning includes combined i.v. administration of a cholinesterase reactivator (an oxime), a muscarinic cholinergic receptor antagonist (atropine) and a benzodiazepine anticonvulsant (diazepam). The objective of this study was to evaluate, in a realistic setting, the therapeutic benefit of administration of GK-11 (gacyclidine), an antiglutamatergic compound, as a complement to the above therapy against organophosphate poisoning. Gacyclidine was injected (i.v.) in combination with atropine/diazepam/pralidoxime at man-equivalent doses after a 45- or 30-min latency period to intoxicated primates (2 LD₅₀). The effects of gacyclidine on the animals' survival, electroencephalographic (EEG) activity, signs of toxicity, recovery after challenge and central nervous system histology were examined. The present data demonstrated that atropine/diazepam/pralidoxime alone or combined with gacyclidine did not prevent signs of soman toxicity when treatment was delayed 45 min after poisoning. Atropine/diazepam/pralidoxime also did not control seizures or prevent neuropathology in primates exhibiting severe signs of poisoning when treatment was commenced 30 min after intoxication. However, in this latter case, EEG recordings revealed that additional treatment with gacyclidine was able to stop soman-induced seizures and restore normal EEG activity. This drug also totally prevented the neuropathology observed 5 weeks after soman exposure in animals treated with atropine/diazepam/pralidoxime alone. Overall, in the case of severe OP-poisoning, gacyclidine represents a promising adjuvant therapy to the currently available polymedication to ensure optimal management of organophosphate poisoning in man. This drug is presently being evaluated in a human clinical trial for a different neuroprotective indication. However, it should always be kept in mind that, in the case of severe OP-poisoning, medical intervention must be conducted as early as possible. Received: 30 November 1998 / Accepted: 12 January 1999     

High concentrations of pralidoxime are needed for the adequate reactivation of human erythrocyte acetylcholinesterase inhibited by dimethoate in vitro.

Due to the current controversy about the real effectiveness of the oximes in the treatment of organophosphate poisoning, the reactivation capacity of pralidoxime has been evaluated in vitro on human erythrocyte acetylcholinesterase inhibited by dimethoate. In the in vitro model, a partial recovery of acetylcholinesterase activity was observed with concentrations from 0.066 mM pralidoxime, probably useful enough to prevent death in most cases in vivo. However, much more effectiveness was observed with concentrations up to 0.70 mM pralidoxime. Although pralidoxime should be applied as soon as possible after organophosphate exposure, the application of the antagonist can be useful even 24h after, particularly for organophosphates with biological half-life longer than one day. The protective capacity of pralidoxime after the application was reduced up to 50% in 6h and disappeared almost completely in 24h. Furthermore, the pesticide and its metabolites remained active and were able to inhibit the enzyme as soon as pralidoxime reduced its antagonist capacity. Our results in conjunction with the short half-life of pralidoxime suggest that the maintenance of higher plasmatic concentrations than the currently used should be considered in the management of severe poisoned patients, although adverse effects could be expected.     

盐酸戊乙奎醚救治有机磷农药中毒30例观察

目的 探讨盐酸戊乙奎醚治疗有机磷农药中毒的临床观察,方法 30例有机磷农药中毒患者均给予足量盐酸戊乙奎醚肌注,并配合氟解磷定治疗.结果 30例患者全部治愈出院,治愈率100%.结论 盐酸戍乙奎醚救治有机磷农药中毒起效快、病程短、毒副作用少、治愈率高,住院时间短,费用低.     

盐酸戊乙奎醚治疗急性有机磷农药中毒的临床研究

目的：观察盐酸戊乙奎醚（长托宁）在抢救急性有机磷农药中毒患者中的临床疗效。方法：将本院进行抢救的47例急性有机磷农药中毒患者作为观察组,给予盐酸戊乙奎醚联合氯解磷定治疗;既往本科应用传统的阿托品加氯解磷定进行抢救的47例急性有机磷中毒患者作为对照组,比较两组患者的临床疗效。结果：观察组的临床疗效、平均住院时间、CHE恢复时间、中毒症状消失时间及意识清醒时间与对照组比较,差异均有统计学意义（P〈0.05）;并且不良反应的发生率仅为10.6%,明显比对照组少（P〈0.05）。结论：盐酸戊乙奎醚（长托宁）治疗急性有机磷农药中毒患者疗效确切,不良反应少,值得广泛应用。     

The effects of fresh frozen plasma on cholinesterase levels and outcomes in patients with organophosphate poisoning

OBJECTIVE: The aim of this study is to determine the effects of fresh frozen plasma, as a source of cholinesterase, on butyrylcholinesterase (BuChE; plasma or pseudo cholinesterase) levels and outcomes in patients with organophosphate poisoning. MATERIALS AND METHODS: This prospective study was performed at the Department of Intensive Care of Erciyes University Medical School. Over 2 yrs, patients admitted to the ICU for OP poisoning were entered into the study. OP poisoning was diagnosed on the basis of history and BuChE levels. All patients received atropine. Fresh frozen plasma was given to 12 patients. The study was approved by the Ethical Committee, and verbal informed consent was obtained. RESULTS: Thirty-three patients were included in the study. BuChE levels measured at admission and the pralidoxime and atropine doses administered were not different between groups (p>0.05). Although intermediate syndrome developed in 28.6% of patients receiving pralidoxime, there were no intermediate syndrome cases in patients receiving plasma prior to developing intermediate syndrome. The mortality rates were 14.3% in the pralidoxime group and 0% in the plasma+atropine+pralidoxime group. Two patients received plasma after developing the intermediate syndrome, and one patient who received only atropine died. BuChE levels of fresh frozen plasma were 4069.5 +/- 565.1 IU/L. Every two bags of plasma provided an increase in BuChE levels of approximately 461.7 +/- 142.1 IU/L. CONCLUSION: Fresh frozen plasma therapy increases BuChE levels in patients with organophosphate poisonings. The administration of plasma may also prevent the development of intermediate syndrome and related mortality. Plasma (fresh frozen or freshly prepared) therapy may be used as an alternative or adjunctive treatment method in patients with organophosphate pesticide poisoning, especially in cases not given pralidoxime. Further randomized controlled and animal studies are required to infer a definitive result.