急性混配农药中毒78例的临床分析  

Clinical analysis of 78 cases of acute combined pesticides poisoning

作　　者：黄金祥[1] 何凤生[1] 鲁锡荣[1] 王玉萍[1] 陈巍[1] 牛勇[1] 王佩丽[2] 韩毓珍[3] 张巡淼[3] 陈劼 秦复康[4] 陈长清 朱炳亮[6] 

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]上海市疾病预防控制中心预防性体检办公室 [3]上海市职业病医院中毒科 [4]山东省滕州市中心人民医院内二科 [5]河北省沧州市中心人民医院急诊科 [6]苍山县人民医院急诊科

出　　处：《中华劳动卫生职业病杂志》2001年第4期247-250,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　了解急性混配农药中毒的临床表现特点 ,以提高混配农药中毒的诊治水平。方法　在 3个县市级医院 ,对 78例急性混配农药中毒患者进行临床观察和诊治研究。结果　分别观察急性口服和生产性混配农药中毒 3 7和 4 1例 ,其中有机磷杀虫剂 (OP)与OP混配 3 0例 (OP +OP组 ) ;OP与拟除虫菊酯杀虫剂 (PY)混配 2 3例 (OP +PY组 ) ;OP与氨基甲酸酯杀虫剂 (CB)混配 8例 (OP+CB组 ) ;OP与其他农药混配 12例 (OP +其他组 ) ;CB与PY或其他农药 (不包括OP)混配 5例 (CB +PY或其他组 )。 5组患者均有不同程度的急性胆碱能兴奋或危象的临床表现 ,尤以头晕、乏力、多汗、流涎、恶心、呕吐、瞳孔缩小、肌束震颤多见 ,重者出现昏迷、肺部湿 口罗音、大小便失禁 ;全血胆碱酯酶(ChE)活力均下降 ( 11%～ 73 %) ,在急性中毒 1～ 4d胆碱能危象基本控制后 ,OP +OP及OP +PY组中5例出现屈颈肌与四肢近端肌肉及颅神经支配的肌肉无力 ,其中 3例出现呼吸肌无力 ,需进行机械呼吸。参照相关诊断标准及分级建议 ,诊断为急性轻度、中度和重度混配农药中毒 3 1、3 0和 17例 ,其中合并轻型“中间期肌无力综合征 (IMS)”2例、重型IMS 3例。经彻底洗胃和清洗污染的皮肤 ,给予解毒药阿托品和氯解磷定、碘解磷定以及对症和支持治疗 ,除OPObjective To explore the clinical features of acute combined pesticides poisoning and to improve its art of the diagnosis and treatment. Methods Clinical observations of 78 patients with acute combined pesticides poisoning were conducted in 3 hospitals.T5'HZ] Results 37 cases of acute oral poisoning and 41 cases of acute occupational poisoning caused by spraying combined pesticides were observed during the period of 1996～2000.The patients were divided into 5 groups according to their exposure to various agents of pesticides:organophosphate(OP)+OP(30 cases),pyrethroid(PY)+OP(23 cases),carbamate(CB)+OP(8 cases),other pesticides+OP(12 cases),CB+PY or others(5 cases).All patients showed varying degree of acute cholinerigic symptoms and signs mainly including dizziness,weakness,profuse sweating,excessive salivation,nausea,vomiting,miosis and muscle fasciculation.Coma,moist rales in the lungs and incontinence of urine or feces were found in the seriously ill cases.The whole blood ChE activities were decreased by 11%～73%.Weakness of neck flexors and proximal limb muscles as well as muscles innervated by motor cranial nerves occurred about 1～4 days after acute poisoning in 5 cases of Groups 'OP+OP' and 'PY+OP' who had already recovered from acute cholinergic crisis.Of them,3 cases revealed weakness of respiratory muscles.Referring to the related criteria of diagnosis and gradation of insecticide poisoning,31 cases were diagnosed as acute mild combined pesticides poisoning,30 as moderate poisoning and 17 as severe poisoning,2 of them were complicated with mild 'intermediate myasthenia syndrome(IMS)' and 3 with severe IMS.Comprehensive treatment included thorough decontamination of skin or gastric lavage,atropine and pralidoxime chloride or iodide as specific antidotes and symptomatic and supportive therapy as well as endotracheal intubation and mechanical ventilation for severe poisoning.After the above treatment,77 cases were recovered except 1 cases of severe oral(OP+OP) poisoning died of respiratory failure. C

关 键 词：农药中毒 急性混配农药中毒 诊断 治疗 临床表现 病例报告 

分 类 号：R139[医药卫生—劳动卫生]