急性氨基甲酸酯及其与有机磷等混配农药中毒的临床治疗研究  

Clinical study on therapy of acute poisoning of carbamate or its mixture with organophosphate or other pesticides

作　　者：黄金祥[1] 李慧[1] 秦复康[2] 鲁锡荣[1] 王玉萍[1] 陈巍[1] 何凤生[1] 王佩丽[3] 韩毓珍[4] 张巡淼[4] 

机构地区：[1]中国预防医学科学院劳动卫生与职业病研究所职业病与健康监护研究室,北京100050 [2]山东省滕州市中心人民医院内二科 [3]上海市疾病预防控制中心预防性体检办公室 [4]上海市职业病医院中毒科

出　　处：《中华劳动卫生职业病杂志》2001年第4期243-246,共4页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：国家科学技术委员会"九五"科技攻关项目 ( 96 90 6 0 4 11)

摘　　要：目的　探讨肟类药物对氨基甲酸酯 (CB)类农药与有机磷杀虫剂 (OP)混配中毒的疗效。方法　对收治的 11例急性单纯CB(灭多威 )及其与OP等其他农药混配中毒的患者进行临床观察、实验室检查 [包括全血胆碱酯酶 (ChE)活力测定 ]及治疗。患者入院后彻底清洗污染的皮肤或洗胃 ,并给予阿托品 (At)和肟类药物治疗及对症处理。根据病情轻重 ,At首剂用量为 1～ 10mg ,总用量为 6.4～10 1.0mg;肟类药物除 2例用碘解磷定外 ,其余均给予氯解磷定治疗 ,用量 0 .5～ 3 0 .0g。结果　所有患者治疗后急性胆碱能兴奋或危象的症状和体征逐渐减轻和消失 ,用肟类药物者未见明显的不良反应 ,5例中、重度中毒患者在给予氯解磷定治疗后 3～ 2 4h内肌束震颤消失。绝大多数患者全血ChE活力恢复到正常水平 ( 87%～ 10 1%)。全部患者住院 2～ 8d ,痊愈出院。结论　急性灭多威与OP混配中毒 ,可用足量At并谨慎使用肟类ChE复能剂治疗。氯解磷定对急性中、重度OP与CB混配中毒患者出现的烟碱样症状有较好的疗效。Objective To clarify whether pralidoxime therapy is effective in carbamate(CB) mixed with organophosphate(OP) poisoning. Methods After exposure history of pesticides was taken,physical examination,clinical observations and treatment were carried out in 11 cases of acute poisoning of methomyl or its mixture with OP and other pesticides.Laboratory tests included the determination of whole blood ChE activities.All patients received atropine and oxime treatment as well as thorough decontamination of skin and gastric lavage.The initial and total atropine dose was 1～10 mg and 6.4～101.0 mg respectively according to the severity of intoxication.Except that 2 patients were given pralidoxime iodide 0.5～1.5 g,others were treated with 0.5～30.0 g of pralidoxime chloride. Results All poisoning patients recovered from acute cholinergic excitation or crisis after treatment.No obvious adverse effects were seen with paralidoxime therapy.The muscle fasciculation in 5 cases of moderate or severe poisoning disappeared within 3～24 hours after administration of oxime.Inhibited ChE activity were reactivated to normal level(87%～101%) in most cases.All patients were discharged from the hospital on 2～8 d. Conclusions Pralidoxime is effective against muscular fasciculation and other nicotinic effects and can be used as auxiliary therapeutic drugs for atropine in the treament of acute insecticide mixture poisoning of methomyl and OP.

关 键 词：农药中毒 急性氨基甲酸酯中毒 有机磷中毒 治疗 混配农药中毒 

分 类 号：R595.4[医药卫生—内科学]