盐酸戊乙奎醚联合阿托品救治重度急性有机磷农药中毒的疗效观察  

The trial of penehyclidine hydrochloride combined with atropine in treatment of patients with severe acute organophosphorus poisoning

作　　者：刘霖敏[1] 陈斌 陈华彬[1] 卢中秋[3] 

机构地区：[1]浙江省台州市立医院,浙江台州318000 [2]江西省全南县人民医院,江西全南341800 [3]温州医科大学附属第一医院急诊医学中心,浙江温州325000

出　　处：《中国中西医结合急救杂志》2014年第3期205-208,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：浙江省“十二五”省高校重点学科（浙教高科[2012]80-207）;浙江省医学创新学科建设计划（浙卫发[2011]230-11-CX26）;浙江省中医药重点学科建设计划（浙卫发[2012]196-2012-XK-A28）

摘　　要：目的观察盐酸戊乙奎醚（长托宁）联合阿托品治疗重度急性有机磷农药中毒（AOPP）的临床疗效。方法回顾性分析2004年1月至2012年9月浙江省台州市立医院和江西省全南县人民医院收治的64例重度AOPP患者的临床资料。根据抗胆碱药物的选择与应用方法不同分为长托宁联合阿托品组（32例）和阿托品治疗组（32例）。比较两组抗胆碱能药物使用情况、呼吸机使用时间、胆碱酯酶（ChE）活性恢复70％时间、住院时间、并发症发生率、治愈率。结果与阿托品组治疗比较，长托宁联合阿托品组阿托品总使用量明显减少（mg：35．39±45．76比105．46±139．87，P〈0．05）；呼吸机使用时间（d：5．3±4．2比7．8±6．8）、ChE活性恢复70％时间（d：8．2±3．8比11．0±5.4）、住院时间（d：12．0±3．8比14．6±5．3）均明显缩短（均P〈0．05）；并发症总发生率明显降低[68．75％（22／32）比93．75％（30／32），P〈0．05]；长托宁联合阿托品组与阿托品治疗组治愈率比较差异无统计学意义[96．87％（31／32）比90．62％（29／32），P〉0．05]。结论长托宁联合阿托品治疗重度AOPP能明显提高其疗效，减少并发症，缩短住院时间。Objective To observe the clinical effect of penehyclidine hydrochloride （Changtuoning）combined with atropine in treatment of patients with severe acute organophosphorus poisoning （AOPP）. Methods The clinical data of 64 patients with severe AOPP admitted into Taizhou Municipal Hospital in Zhejiang Province and Quannan County People＇s Hospital in Jiangxi Province from January 2004 to September 2012 were retrospectively analyzed. Patients were divided into penehyclidine hydrochloride and atropine combined group （PH-A group, 32 cases） and atropine treatment group （32 cases） depending on the difference in selection and application method of anticholinergic drugs. The application of anticholinergic drugs, length of mechanical ventilation, 70% cholinesterase （ChE） activity recovery time, length of stay in hospital, incidence of complications, and cure rate were compared between the two groups. Results Compared with atropine treament group, the total usage of atropine in PH-A group was significantly decreased （mg ： 35.39 ±45.76 vs. 105.46 ± 139.87, P〈0.05）, the length of mechanical ventilation （days ： 5.3 ± 4.2 vs. 7.8 ± 6.8, P〈 0.05）, 70% ChE activity recovery time （days ： 8.2 ± 3.8 vs. 11.0 ± 5.4, P〈 0.05 ）, and length of stay in hospital （days ： 12.0 ± 3.8 vs. 14.6 ± 5.3, P〈 0.05） were significantly shortened in PH-A group, and the overall incidence of complications were significantly lowered in PH-A group [ 68.75 % （22/32） vs. 93.75% （30/32）, P〈0.053- The difference in cure rate between the combined group and atropine treatment group was not statistically significant [ 96.87% （31/32） vs. 90.62% （29/32）, P 〉0.053. Conclusion Penehyclidine hydroehloride combined with atropine in the treatment of severe AOPP can significantly improve the therapeutic efficacy, reduce the incidence of complications and length of stay in hospital.

关 键 词：盐酸戊乙奎醚 阿托品 急性中毒 有机磷农药 

分 类 号：R595.4[医药卫生—内科学]