重度急性有机磷农药中毒院前系统救治的研究
王维展，李雅琴，王岚，周凤举，王学忠，扈晓霞，王美琴，马国营,亢宏山，赵玲俊，李敬【摘要】 目的 评价现场系统救治重度急性有机磷农药中毒(SAOPP)的可行性、安全性和有效性。方法将223例SAOPP患者分为两组，携带抢救器械、药品到现场给予系统救治者116例为院前组，到医院后开始治疗者107例为院内组。院前组分为A、B两个亚组A组85例采用全自动洗胃机洗胃；B组31例采用吊桶洗胃法洗胃，在洗胃同时予以抗毒剂氯磷定、阿托品，在此基础上依据病情给予其他综合治疗措施。动态监测胆碱酯酶(ChE)活性，观察中毒症状消失时间、阿托品化时间、阿托品用量、氯磷定用量、ChE恢复时间、病死率、住院时间及并发症发生率。结果院前组的中毒症状消失时间、阿托品化时间、ChE恢复时间、阿托品和氯磷定用量及住院时间均明显少于院内组，病死率也明显低于院内组(P<0.05或P<0.01)；呼吸衰竭、心脏损害、脑损害及阿托品中毒发生率院前组显著低于院内组(P均<0.01) ，而中间综合征(IMS)、反跳、肝脏损害等两组比较差异无显著性(P均>0.05)；院前A、B两组病死率、住院时间等各项指标比较无显著性差异(P均>0.05)。结论院前救治SAOPP疗效显著，是一种安全有效的治疗方法，宜于推广。
【关键词】 有机磷农药； 中毒； 重度； 系统救治； 院前急救
Pre-hospital systematic treatment for patients with severe acute organophosphorus pesticide poisoning WANG Wei-zhan, LI Ya-qin, WANG Lan, ZHOU Feng-ju, WANG Xue-zhong, HU Xiao-xia, WANG Mei-qin, MA Guo-ying, KANG Hong-shan, ZHAO Ling-jun, LI Jing.Emergency Department, Harrison International Peace Hospital, Hengshui 053000, Hebei, China
【Abstract】 OBJECTIVE: To evaluate the feasibility, safety and effectiveness of on-spot systematic treatment for the patients with severe acute organophosphorus pesticide poisoning (SAOPP). METHODS: Two hundred and twenty-three SAOPP patients were divided into two groups: pre-hospital treatment group (116 patients), in which rescue equipments and drugs were carried to the spot for the treatment of the patients; hospital treatment group (107 patients), in which the patients received emergency treatment after reaching the hospital. The pre-hospital group was sub-divided into group A and group B. In group A, gastric lavage was performed with aid of automatic lavage instrument, and in group B lavage was done by using suspending buckets. Antidotes including pralidoxime chloride and atropine were used simultaneously based on the patients' conditions. Cholinesterase (ChE) activity was dynamically monitored. When the symptoms disappeared, the length of atropinization, the total dosage of atropine and pralidoxime chloride, the recovery time of ChE, the mortality, hospital days, and the incidence of complications were analyzed. RESULTS: The therapeutic effect in pre-hospital group was better than that in in-patient group in terms of disappearance of the symptoms, length of atropinization, recovery time of ChE, the total dosage of atropine and pralidoxime chloride, hospital days, and the mortality rate in group A was markedly lower than in-patient group(P<0.05 or P<0.01). The incidence of respiratory failure, heart injury, brain injury, and atropine poisoning were also lower in pre-hospital group compared with in-patient group (all P<0.01). However, there were no significant differences in intermediate syndrome, relapse, liver injury (all P>0.05). On the other hand, there were no significant differences in mortality rate and hospital days between two subgroups of pre-hospital treatment group(P>0.05). CONCULSION: Pre-hospital systematic treatment for SAOPP patients, due to its good effects, should be recommended as a safe and effective treatment strategy. ......
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