由乐果导致的重度急性有机磷中毒合并脓毒性休克的治疗体会  

Treatment of severe acute organophosphate pesticide poisoning with septic shock induced by Dimethoate

作　　者：张艳芳[1] 姚垚 邓莹 熊穗 马力 陈国兵[3] Zhang Yanfang;Yao Yao;Deng Ying;Xiong Sui;Ma Li;Chen Guobing(Department of Internal Medicine Intensive Care Unit,the First People's Hospital of Yunnan Province,Kunming 650032,Yunnan,China;Department of Emergency Medicine,New Kunhua Hospital of the First People's Hospital of Yunnan Province,Kunming 650301,Yunnan,China;Department of Emergency,the First People's Hospital of Yunnan Province,Yunnan 650032,Kunming,China)

机构地区：[1]云南省第一人民医院MICU,云南昆明650032 [2]云南省第一人民医院新昆华医院急诊医学部,云南昆明650301 [3]云南省第一人民医院急诊科,云南昆明650032

出　　处：《中国中西医结合急救杂志》2024年第1期100-102,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家自然科学基金(82160366)。

摘　　要：目的描述1例重度急性有机磷中毒(AOPP)合并复发性呼吸衰竭、中间综合征(IMS)、多器官功能障碍综合征(MODS)和脓毒症的诊断、治疗及临床病程。方法云南省第一人民医院内科重症监护病房(MICU)于2021年5月8日收治了1例自服农药乐果AOPP患者,经过29d的治疗痊愈出院。介绍临床诊治过程。结果患者男性,78岁,因自服农药乐果导致AOPP。入院后迅速出现呼吸衰竭,经紧急气管插管接呼吸机辅助呼吸,并进行一系列针对性治疗,包括应用复能剂碘解磷定、阿托品和山若碱,以及抗菌药物、维持水电解质和酸碱平衡等。在治疗过程中,患者病情经历了多次反复,如脓毒症发作、胆碱酯酶(ChE)水平大幅波动、多重耐药菌感染、呼吸衰竭反复出现等情况。最终,经过29d的治疗,患者成功脱离呼吸机,各器官功能恢复正常出院。结论通过对该病例的分析,提示在AOPP救治过程中需密切关注调整药物剂量,防治感染、脓毒性休克和呼吸机相关性肺炎(VAP)的发生,并及时心理评估和干预的重要性。Objective To describe the diagnosis,treatment,and clinical course of a patient with severe acute organophosphorus pesticide poisoning(AOPP)complicated by recurrent respiratory failure,intermediate syndrome(IMS),multiple organ dysfunction syndrome(MODS)and sepsis.Methods On May 8,2021,a patient who self-administered the pesticide Dimethoate AOPP was admitted to the department of internal medicine intensive care unit(MICU)of the First People's Hospital of Yunnan Province.After 29 days of treatment,the patient was successfully cured and discharged.The clinical diagnosis and treatment process was introduced.Results The 78-year-old male patient suffered from severe AOPP due to self-ingestion of the pesticide leptophos.Upon admission,he rapidly developed respiratory failure requiring urgent endotracheal intubation and mechanical ventilation support.A series of targeted treatments were administered,including the use of reactivators such as pralidoxime iodide,anticholinergic agents like atropine and scopolamine,as well as antibiotic therapy and management of water-electrolyte balance and acid-base equilibrium.Throughout his treatment,the patient experienced multiple complications,including episodes of sepsis,fluctuating cholinesterase levels,infections from multidrug-resistant bacteria,and recurrent respiratory failures.After 29 days of meticulous care,the patient was successfully weaned off the ventilator,regained normal organ function,and was discharged.Conclusion The analysis of this case highlights the importance of closely monitoring and managing drug dosage adjustments,preventing and treating infections,addressing septic shock,paying attention to the prevention and control of ventilator-associated pneumonia(VAP),conducting timely psychological evaluations,and providing interventions during the treatment process for AOPP.

关 键 词：急性有机磷中毒 呼吸衰竭 中间综合征 脓毒症 呼吸机相关性肺炎 感染控制 

分 类 号：R595.4[医药卫生—内科学] R459.7[医药卫生—临床医学]