盐酸戊乙奎醚阶梯方案对重度有机磷中毒及中间综合征的临床研究

目的:探讨盐酸戊乙奎醚(长托宁)阶梯方案对急性重度有机磷农药中毒(AOPP)及中间综合征(IMS)的临床效果。方法:82例重度AOPP随机分为治疗组和对照组,治疗组(n=43)采用6 h长托宁阶梯方案:负荷量按照曾繁忠推荐用法,长托宁4~6 mg肌注,首剂后1 h长托宁2~3 mg 1次/h,连用2次后,2~3 mg 2次/h连用2次,2mg 1次/4~6 h为维持量;对照组(n=41)按以上推荐负荷量后0.5~1h常规长托宁2 mg 1次/4~6 h肌内注射为维持量。氯磷定治疗方法相同。根据长托宁化及其意识、体温等调整维持量。结果:与对照组相比,治疗组达到长托宁化的时间(t=8.551,P<0.01)、IMS发生率(2χ=7.201,P<0.01)明显低于对照组,机械通气时间(t=11.491,P<0.05)、死亡率(2χ=4.808,P<0.05)明显低于对照组;总长托宁用量比较,无统计学意义(t=0.482,P(0.05)。无长托宁严重反应及中毒死亡的患者。结论:长托宁阶梯方案能早期4h达到长托宁化,与常规用法相比,能更明显降低重度AOPP的死亡率及IMS的发生率。

Clinical study on Penehyclidine hydrochloride ladder program for severe organophosphate poisoning and intermediate syndrome

Objective To explore the clinical effects of Penehyclidine（Long-Thorning） ladder program on acute severe organophosphorus pesticide poisoning（AOPP） and intermediate syndrome（IMS）.Method Total 82 patients with severe AOPP were randomly divided into the treatment group and the control group.The treatment group（n=43） received Long-Thorning ladder program,the first dose according to Zeng Fanzhong recommended usage,Long-Thorning 4-6mg intramuscular injection,after the first dose of 1h,Long-Thornin 2-3mg q1h ×2,2-3mg q2h×2,2mg q4-6h intramuscularly to maintain the amount.The control group（n=41） according to the above recommendation,after loading 0.5-1h,Long-Thorning 2mg q4-6h order to maintain the amount.PAM-treated the same way.Results Time spent to achieve Long-Thorning and IMS incidence rate of the treatment group were significantly lower than the control（t=8.551,χ2=7.201,P0.01）,duration of mechanical ventilation and mortality were lower than the control（t=11.491,χ2=4.808,P0.05）.Conclusion Long-Thorning ladder program can reduce IMS incidence rate and mortality of the patients with severe AOPP.