急性有机磷农药中毒中间综合征15例临床分析

目的探讨急性有机磷农药中毒（AOPP）中阎综合征（IMS）的诊断治疗。方法对15例IMS的临床表现、血清胆碱酯酶（ChE）活力、病程等进行分析，并观察药物及呼吸机治疗的疗效和转归。结果IMS的发生率占同期收治的AOPP的13．8％，IMS症状出现在急性中毒后36～118h，15例均出现呼吸困难、抬头困难、屈颈肌力弱及肢体近端肌无力，血清ChE活力低下，当IMS患者出现呼吸衰竭时应使用呼吸机治疗，同时合理使用阿托品、胆碱酯酶复能剂．经抢救治愈9例，死亡3例，放弃治疗3例。结论IMS发生率及病死率高，早期诊断及时治疗是提高IMS抢救成功率、降低病死率的关键。

Clinical Analysis of Intermediate Syndrome Complicating Acute Organophosphorus Pesticide Poisoning

Objective To investigate the diagnosis and treatment of intermediate syndrome（IMS） after acute organophosphorus pesticides poisoning（AOPP）. Methods The clinical manifestations, cholinesterase activity, disease course, etc. of 15 cases with IMS were analyzed retrospectively, and the therapeutic effects of medications and mechanical ventilation and outcome were ob- served. Results The incidence of IMS was 13.8% in patients with AOPP hospitalized coincidently. The symptoms of IMS occurred at 36 to 118 hours after acute poisoning. All the 15cases showed difficulty in breathing and elevating their heads,weakness of the flexor muscles of neck and proximal limbs without concomitant sensory disturbance. The cholinesterase activity was lower. The mechanical ventilation（respirator） was timely performed in patients with respiratory failure, combined with the treatment of pralidoxime and atropine. 9 cases were cured,3 cases died and 3 cases refused treatment. Conclusion IMS has a substantial incidence with high case-fatality rate. The early diagnosis and promptly treatment is the key factor to raise the successful rate of salvage.