氯解磷定联合不同剂量阿托品治疗重度有机磷农药中毒的回顾性分析  

Retrospective analysis of combination of pralidoxime chloride with different dosage of atropine in the treatment of severe organophosphorus pesticide poisoning

作　　者：董晖[1] 李凤杰[1] 金爱春[1] 郭金成[2] DONG Hui;LI Feng-jie;JIN Ai-chun;GUO Jin-cheng(Department of Emergency Medicine,Beijing Luhe Hospital Affiliated to Capital Medical University,Beijing 101149,China;Department of Cardiology,Beijing Luhe Hospital Affiliated to Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京潞河医院急诊内科,北京101149 [2]首都医科大学附属北京潞河医院心内科,北京101149

出　　处：《实用药物与临床》2022年第1期62-66,共5页Practical Pharmacy and Clinical Remedies

基　　金：首都卫生发展科研专项项目(首发2018-2-7082)。

摘　　要：目的回顾性分析氯解磷定联合不同剂量阿托品治疗重度有机磷农药中毒(SOPP)的疗效。方法收集2019年4月至2021年4月于本院接受治疗的105例SOPP患者的资料进行回顾性分析,根据患者阿托品使用剂量分为大剂量组(最大剂量>100 mg/h,共57例)和小剂量组(最大剂量≤100 mg/h,共48例)。两组均予以洗胃、器官支持、氯解磷定、阿托品等治疗,比较两组入院时与治疗3 d后的血清胆碱酯酶(ChE)、肌酸激酶(CK)、乳酸脱氢酶(LDH)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、阿托品总用量、机械通气时间、中毒缓解时间、ICU停留时间、住院总时间、阿托品中毒率、治愈率与死亡率。结果两组入院时的血清ChE、CK、LDH比较,差异无统计学意义(P>0.05)。治疗3 d后,两组血清ChE、CK、LDH均大幅降低(P<0.05)。大剂量组治疗3 d后的血清ChE[(0.47±0.11)kU/L vs.(0.54±0.14)kU/L]、CK[(126.33±28.92)U/L vs.(141.74±30.25)U/L]低于小剂量组(P<0.05),两组治疗3 d后的血清LDH比较差异无统计学意义(P>0.05)。两组机械通气时间比较差异无统计学意义(P>0.05)。大剂量组阿托品总用量[(4668.43±631.20)mg vs.(1341.51±162.32)mg]高于小剂量组,中毒缓解时间[(8.46±1.47)h vs.(9.43±1.54)h]短于小剂量组(P<0.05)。两组ICU停留时间、住院总时间比较,差异无统计学意义(P>0.05);大剂量组阿托品中毒率(35.09%vs.14.58%)高于小剂量组,痊愈率(89.47%vs.62.50%)高于小剂量组(P<0.05)。结论大剂量应用阿托品治疗SOPP的效果优于常规剂量,但需要严密观察病情,在足量的前提下个体化使用阿托品,有利于降低阿托品中毒风险。Objective To retrospectively analyze the efficacy of pralidoxime chloride combined with different dosage of atropine in the treatment of severe organophosphorus pesticide poisoning(SOPP).Methods A retrospective analysis was carried out in 105 SOPP patients who were treated in our hospital from April 2019 to April 2021.According to the dosage of atropine,the patients were divided into high-dose group(maximum dose>100 mg/h,57 cases in total)and small-dose group(maximum dose≤100 mg/h,48 cases in total).Both groups were given gastric lavage,organ support,pralidoxime chloride,atropine and other treatments.Compare the following items between the two groups on admission and after 3 days of treatment:serum cholinesterase(ChE),creatine kinase(CK),lactate dehydrogenase(LDH),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total atropine dosage,mechanical ventilation time,poisoning remission time,ICU stay time,total hospitalization time,atropine poisoning rate,cure rate and mortality.Results There was no significant difference in serum ChE,CK or LDH between the two groups on admission(P>0.05).After 3 days of treatment,the serum ChE,CK and LDH of the two groups were significantly reduced(P<0.05).The serum ChE[(0.47±0.11)kU/L vs.(0.54±0.14)kU/L],CK[(126.33±28.92)U/L vs.(141.74±30.25)U/L]after 3 days of treatment in the high-dose group were lower than those in the low-dose group(P<0.05),but there was no significant difference in serum LDH between the two groups after 3 days of treatment(P>0.05).There was no significant difference in the mechanical ventilation time between the two groups(P>0.05).The total dosage of atropine in the high-dose group[(4668.43±631.20)mg vs.(1341.51±162.32)mg]was higher than that in low-dose group,and the remission time of poisoning[(8.46±1.47)h vs.(9.43±1.54)h]was shorter(P<0.05).There was no significant difference in ICU stay time or total length of hospitalization between the two groups(P>0.05);the atropine poisoning rate(35.09%vs.14.58%)in high-dose group was higher than th

关 键 词：重度有机磷农药中毒 氯解磷定 阿托品 剂量 胆碱酯酶 

分 类 号：R595.4[医药卫生—内科学]