氯解磷定对不同有机磷杀虫剂中毒后乙酰胆碱酯酶活力恢复的影响  

Different therapeutic efficacy of parlidoxime chloride (PAM-CI) on AChE against acute toxicity of methamidophos,dichlorovs and omethoate

作　　者：万伟国[1] 郑舒聪[1] 邹和建[1] 马升弟[2] 陶光洲[3] 许祖芳[4] 张斌[5] 陈家进 方灵云 朱志杰[7] 

机构地区：[1]复旦大学附属华山医院职业病科,上海200040 [2]浙江省金华市中心医院 [3]江苏省淮安市第一人民医院 [4]江西省兴国县人民医院 [5]江西省吉安县人民医院 [6]浙江省浦江县中医院 [7]安徽省绩溪县人民医院

出　　处：《中华劳动卫生职业病杂志》2007年第10期586-589,共4页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：科技部"十五"科技攻关项目基金资助(2001BA704B06)

摘　　要：目的比较氯解磷定(PAM-Cl)对急性甲胺磷、敌敌畏和氧乐果中毒后乙酰胆碱酯酶(AChE)活力恢复的影响,为临床上合理治疗提供科学依据。方法收集4省1市7家县、市级医院收治的101例急性有机磷杀虫剂中毒患者资料,按接触杀虫剂品种不同分为急性甲胺磷中毒组59例、急性敌敌畏(或敌百虫)中毒组32例、急性氧乐果中毒组10例,比较3组患者红细胞AChE活力抑制程度和PAM-CI对AChE的复能作用。结果入院时甲胺磷组、敌敌畏组、氧乐果组红细胞AChE活力分别为(9.12±7.99)、(7.32±4.62)和(12.01±9.53)U/gHb,均受抑制,但差异无统计学意义(P>0.05)。经PAM-Cl治疗后3组患者中毒症状减轻或消失。甲胺磷组红细胞AChE活力在治疗后12、24、48、72 h及出院时分别为(11.37±8.67)、(12.51±6.98)、(15.90±7.31)、(18.33±4.78)及(18.91±7.00)U/g Hb,均较入院时明显升高并且呈不断回升趋势,差异有统计学意义(P<0.01或P<0.05)。敌敌畏组患者AChE活力在治疗后3、12、24、48、72 h及出院时均较入院时明显增高,差异有统计学意义(P<0.05);12 h后各时间点AChE活力则无进一步上升。氧乐果组患者AChE活力只有出院时较入院时明显增高,差异有统计学意义(P<0.05);其余各时间点AChE活力较入院时始终无明显恢复,差异均无统计学意义(P>0.05)。结论PAM-Cl对甲胺磷、敌敌畏、氧乐果中毒均有治疗作用,对甲胺磷抑制的AChE活力有明显的重活化作用,对敌敌畏(敌百虫)抑制的AChE活力有一定重活化作用,而对氧乐果(乐果)抑制的AChE活力无重活化作用。Objective To observe the treatments on the patients with acute methamidophos dichlorovs （DDV）and omethoate poisoning and provide the reliable basis for the rational treatments on these three organophosphorus pesticides poisoning. Methods 101 patients with AOPP in 7 hospitals were devided into three groups： Group A, 59 patients with acute methamidophos poisoning, Group B, 32 patients with acute DDV/dipterex（DEP） poisoning, Group C, 10 patients with acute omethoate/dimethoate poisoning. The levels of erythrocyte AChE and the therapeutic efficacies of pralidoxime chloride （PAM-Cl） were compared among the three groups. Results The AChE activities of all the three groups were inhibited on level of （9.12±7.99）U/g Hb （group A）, 7.32±4.62 U/g Hb （group B） and （12.01±9.53）U/g Hb（group C）, among which no significant dif- ference was found（P〉0.05）. All the patients recovered from acute cholinergic excitation or crisis after the treatment of PAM-Cl.The erythrocyte AChE activities were obviously reactivated in group A three hours later after admission to hospital, each on level of （11.37±8.67）U/g Hb, （12.5 l±6.98）U/g Hb, （15.90±7.31）U/g Hb, （18.33± 4.78）U/g Hb and （18.91±7.00）U/g Hb at the 12th, 24th, 48th, 72nd hour and discharge （P〈0.05）, and the upgrade tendency was continuous.AChE activities in group B were also reactivated after treatment, each on level of （8.91±5.89）U/g Hb, （1.31±6.61）U/g Hb, （13.00±7.55）U/g Hb, （14.22±7.80）U/g Hb, （12.78±7.07）U/g Hb and （16.87±7.06）U/g Hb at the 3rd, 12th, 24th, 48th, 72th hour and discharge, but the upgrade tendency turned slowly after 12 hours;the inhibited AChE activities were not reactivated in group C from the beginning to the end. Conclusion After the treatment of PAM-Cl, the AChE activities of the patients with acute methammi- dophos poisoning could be continuously reactivated; the AChE activities of the patients with acute DDV/DEP poisoning could also be reactivated in 12 hou

关 键 词：有机磷杀虫剂 中毒 胆碱酯酶 氯解磷定 

分 类 号：R595.4[医药卫生—内科学]