有机磷农药中毒的脑部影像学研究

目的 总结急性有机磷农药中毒患者脑MRI和CT的影像学表现，提高早期确诊率。方法 行影像学检查的有机磷中毒患者34例，均为口服中毒。毒物种类：甲胺磷12例，氧化乐果15例，敌敌畏(DDV)3例，甲基对硫磷等4例。按照急性有机磷农药中毒诊断及分级诊断标准，患者分为2组：轻、中度中毒组24例，重度中毒组10例。分别分析2组患者脑CT和(或)MR图像资料，并研究其临床分级与CT或MR影像学表现间的关系。结果 急性有机磷农药中毒所致重度中毒组病例影像学资料：4例中毒后2～3d脑CT或MRI表现为脑水肿(脑沟裂变浅，脑室狭小，脑灰白质分界不清)；3例中毒后3d至3个月表现为双侧基底节、双侧额顶枕皮层低密度区，或长T1、长T2信号，其中1例出现皮层和基底节的短T1信号；1例中毒后6个月表现为脑室增大，脑沟、裂增宽的脑萎缩表现。轻、中度中毒组病例脑CT或MR影像学检查未见异常。结论 脑MRI和CT能够反映重度有机磷农药中毒所致脑损害，为中毒后及时应用脱水剂或激素治疗脑水肿，应用营养脑细胞等药物进行治疗可提供准确的影像学信息。

The brain imaging study of the organophosphorus pesticides poisoning

Objective To summarize the CT and MR imaging findings in acute organophosphorus pesticides poisoning patients, and to improve the early diagnostic ability. Methods The imaging of 34 patients of organophosphorus pesticides poisoning was analyzed, the poisons were all taken orally. The pesticides included methamidophos ( 12 cases ) , omethoate ( 15 cases ) , DDV ( 3 cases ) , and methylparathion (4 cases) . According to the diagnosis and classification diagnosis criterion of acute organophosphorus pesticides poisoning, the patients were divided into two groups: mild or moderate grade group (24 cases) and severe grade group (10 cases). The relationship between the clinic grade and CT and MRI findings was studied. Results In the severe grade group, 4 patients showed brain edema, presenting as sulcus and fissure flattened or disappeared, and ventricles and cisterns narrowed or closed 2-3 days after poisoning. In 3 patients 3 days to 3 months after poisoning, bilateral basal ganglion and cerebral cortex showed prolonged T1 and T2 signals, and high signal intensity was detected on FLAIR, and bilateral basal ganglion low density was revealed on CT. T1 relaxation was shortened, T2WI and FLAIR imaging showed high signal intensity in 1 patient. The imaging of 1 patient 6 months after poisoning showed the cerebral sulcus, fissure and ventricle were enlarged. CT and MRI in the mild or moderate group were normal. By the Fisher's exact probabilities test, the imaging exhibition difference between the severe grade and mild or moderate grade patients was significant. Conclusion The CT and MRI can reflect the brain injury after poisoning, and the imaging exhibitions were various. The imaging information can provide credible foundation for the therapy for lightening the brain edema and nourishing the brain cell.