急性有机磷农药中毒规范化治疗研究

目的 探讨急性有机磷中毒(AOPP)规范化治疗方案.方法 在前期研究的基础上,建立AOPP规范化治疗方案,选择某省农药中毒高发区6家医院开展临床试验研究.结果 6家医院观察期内按照统一规范治疗方案共观察治疗AOPP患者422例,以口服中毒为主(97.16%),中、重度患者占87.44%.以规范治疗前2年的病例作为对照,采用规范治疗后,定点医院AOPP病死率从9.87%降至1.66%,差异有统计学意义(χ2=27.92,P＜0.01),明显低于同期该省报告综合救治水平(病死率为8.92%),差异亦有统计学意义(χ2=26.05,P＜0.01).规范治疗组阿托品平均用量为(37.54±17.76)mg,较传统治疗组[(1280.70±69.22)mg]明显下降,差异有统计学意义(U=439.22,P＜0.01),静脉泵给药优于静脉注射给药.规范治疗组氯解磷定平均用量为(25.55±13.78)g,较传统治疗组[(12.11±3.56)g]明显增加,差异有统计学意义(U=19.48,P＜0.01).未见药物中毒现象.结论 AOPP治疗亟须规范,特别在广大农村地区.此次建立的规范治疗方案取得满意疗效,可明显降低AOPP病死率.

Clinical trial on standard treatment of acute organophosphorus poisoning

Objective To explore the norms of treatment of acute organophosphorus pesticide poisoning (AOPP), and observe the curative effect. Methods On basis of the pre-research, the norms of treatment of AOPP were summarized, and a multi-center clinical trial was performed in 6 hospitals selected from high incidence of AOPP in Shandong Province. Results 422 patients of AOPP in 6 hospitals in observation period were treated and observed by the norms of treatment. Among them, the proportion of oral poisoning was 97.16%, middle and severe degree were 87.44%. Compared with themselves 2 years ago before standard treatment, the curative effect of the norms of treatment for AOPP was much better than before. The mortality rate of AOPP declined from 9.87% to 1.66%(χ2=27.92, P＜0.01), that was much better than the average therapeutic effect level of all our province in the same period (the mortality rate: 8.92%) (χ2=26.05, P＜0.01). The average amount of atropine[(37.54±17.76)mg],dropped greatly[(1280.70±69.22)mg](U=439.22,P＜0.01).The usage of atropine by continuous intravenous injection with venous pump was better than ordinary intravenous injection. The mean dosage of pralidoxime chloride increased twice than the previous (U=19.48,P＜0.01). There was no drug poisoning. Conclusion The standard treatment of AOPP is urgently needed in our country, especially in rural area. By this trial, the satisfactory effect of the norms of treatment for AOPP summarized is observed and it reduces the fatality rate remarkably.