口服有机磷混配农药中毒的临床诊断与救治策略

目的探讨有机磷混配农药的临床诊断与救治策略,降低漏诊、误诊事件的发生,提高整体诊断与治疗水平。方法回顾性分析山东大学齐鲁医院中毒与职业病科2016年1月至2019年5月收治的13例急性有机磷混配农药中毒患者的临床资料,其中男性5例,女性8例;年龄12~72岁,平均(49.69±15.34)岁。总结其临床特点,并结合国内外相关文献报道进行探讨。结果中毒患者口服有机磷农药种类:敌敌畏5例(38.46%),毒死蜱3例(23.08%),甲拌磷2例(15.38%),辛硫磷2例(15.38%),乐果1例(7.69%);与有机磷混配的农药类型:百草枯除草剂6例(46.15%),氯氰菊酯2例(15.38%),溴敌隆鼠药2例(15.38%),乙草胺、草甘膦、阿普唑仑混配中毒各1例(7.69%)。入院时能够明确诊断10例(76.92%),入院后经毒物检测或特异性实验室检查才确诊3例(23.08%)。生存7例(53.85%)、死亡6例(46.15%)。死亡患者中,4例同时口服了大剂量百草枯。结论有机磷混配农药中毒患者具有较高的病死率,早期彻底清除毒物和准确诊断对提高救治成功率具有一定意义;早期准确采集病史是诊断与治疗的基础,具有特殊临床表现的中毒患者需考虑混配农药中毒的可能;毒物浓度检测有对混配农药的诊断具有一定意义。

Clinical diagnosis and treatment strategy of acute organophosphorus mix-formulated pesticide

ObjectiveTo discuss the clinical diagnosis and treatment strategy of acute organophosphorus mix-formulated pesticide orally in order to lower the incidences of missed diagnosis and misdiagnosis and to increase the level of diagnosis and treatment in general. MethodsWe had retrospectively analyzed the clinical data of 13 patients who were poisoned by taking the organophosphorus mix-formulated pesticide orally from January 2016 to May 2019 and summarized their clinical characteristics, with review of relevant domestic and foreign literatures. ResultsThe organophosphorus pesticides taken by patients were: dichlorvos (5 cases, 38.46%), dursban (3 cases, 23.08%), phorate (2 cases, 15.38%), phoxim (2 cases, 15.28%) and dimethoate (1 case, 7.69%). The mixed organophosphorus pesticides taken by patients were as follows: paraquat herbicide (6 cases, 46.15%), cypermethrin (2 cases, 15.38%), bromadiron rat poison (2 cases, 15.38%), glyphosate (1 case, 7.69%), glyphosate (1 case, 7.69%), and alprazolam (1 case, 7.69%). There were 10 patients who were diagnosed correctly and immediately. 3 patients were made definite diagnosis after toxicology test or specific laboratory test. 7 patients survived while 6 patients died. 4 patients took a large amount of paraquat resulting in the death. ConclusionsThe morality rate of patients who were poisoned by organophosphorus mixed with pesticides is relatively higher. Thoroughly removing poison and making a definite diagnosis on the basis of history are beneficial to improve the success rate. Doctors should give consideration to the mixed pesticide when they find patients that have unusual clinical manifestation. Poison concentration test can do help to diagnose whether patients has taken mixed pesticide.