CAJ | 학술논문

目的研究东莨菪碱用于抢救急性重度杀虫脒中毒的治疗效果.方法 72例急性重度杀虫脒中毒患者按入院先后次序,以1:1抽样原则分为Ⅰ、Ⅱ两组.Ⅰ组(36例)应用传统综合疗法,即洗胃、导泻、使用氧化还原剂(亚甲蓝和维生素C)和对症治疗等；Ⅱ组(36例)在传统综合疗法的基础上,加用东茛菪碱.所有患者在入院时、入院后3、7、12、24h均检测高铁血红蛋白水平；在入院后3、7、24、48 h检测血清肌钙蛋白(CTn)Ⅰ和肌酸激酶同工酶(CK-MB)及肝、肾功能；每4h检查1次心电图(ECG),共3d.比较两组患者的疗效及检测指标变化.结果 Ⅰ组治愈31例(86.11％),死亡5例(13.89％)；Ⅱ组36例全部治愈；Ⅱ组治愈率明显高于Ⅰ组,差异有统计学意义(P＜0.05).Ⅱ组患者平均病情好转时间和平均住院天数均明显短于Ⅰ组,差异有统计学意义(P＜0.01).Ⅱ组病例入院后7、24、48h血清中CtnI水平和3、7、24、48 h血清中CK-MB水平均明显低于Ⅰ组,差异有统计学意义(P＜0.05或P＜0.01).入院后3、7、12、24h,Ⅱ组病例的高铁血红蛋白浓度均明显低于Ⅰ组,差异有统计学意义(P＜0.01).入院后3、24、48h,Ⅱ组患者肝、肾功能异常率明显低于Ⅰ组,差异有统计学意义(P＜0.05).Ⅱ组患者入院后第2、3天的ECG异常率(38.89％、11.11％)明显低于Ⅰ组(64.71％、38.71％),差异有统计学意义(P＜0.05).结论东莨菪碱对治疗急性重度杀虫脒中毒有效,对心、肝、肾等重要器官有保护作用,可弥补氧化还原剂药理作用的不足.
목적 연구동랑탕감용우창구급성중도살충미중독적치료효과.방법 72례급성중도살충미중독환자안입원선후차서,이1:1추양원칙분위Ⅰ、Ⅱ량조.Ⅰ조(36례)응용전통종합요법,즉세위、도사、사용양화환원제(아갑람화유생소C)화대증치료등；Ⅱ조(36례)재전통종합요법적기출상,가용동간탕감.소유환자재입원시、입원후3、7、12、24h균검측고철혈홍단백수평；재입원후3、7、24、48 h검측혈청기개단백(CTn)Ⅰ화기산격매동공매(CK-MB)급간、신공능；매4h검사1차심전도(ECG),공3d.비교량조환자적료효급검측지표변화.결과 Ⅰ조치유31례(86.11％),사망5례(13.89％)；Ⅱ조36례전부치유；Ⅱ조치유솔명현고우Ⅰ조,차이유통계학의의(P＜0.05).Ⅱ조환자평균병정호전시간화평균주원천수균명현단우Ⅰ조,차이유통계학의의(P＜0.01).Ⅱ조병례입원후7、24、48h혈청중CtnI수평화3、7、24、48 h혈청중CK-MB수평균명현저우Ⅰ조,차이유통계학의의(P＜0.05혹P＜0.01).입원후3、7、12、24h,Ⅱ조병례적고철혈홍단백농도균명현저우Ⅰ조,차이유통계학의의(P＜0.01).입원후3、24、48h,Ⅱ조환자간、신공능이상솔명현저우Ⅰ조,차이유통계학의의(P＜0.05).Ⅱ조환자입원후제2、3천적ECG이상솔(38.89％、11.11％)명현저우Ⅰ조(64.71％、38.71％),차이유통계학의의(P＜0.05).결론 동랑탕감대치료급성중도살충미중독유효,대심、간、신등중요기관유보호작용,가미보양화환원제약리작용적불족.
Objective To investigate effectiveness of scopolamine on the acute severe chlorphenamidine poisoning patients.Methods 72 cases of acute severe chlorphenamidine poisoning patients were divided into Ⅰ and Ⅱ groups by the principle of a 1:1 sampling according to the order of admission.The Ⅰ group (36 cases) were treated with traditional multimodality therapy,including gastrolavage,catharsis,using reductant-oxidant (methylthioninium chloride and vitamin C),and symptomatic treatment.The Ⅱ group were treated with traditional multimodality therapy and scopolamine at the same times.Blood methemoglobin were measured at 0,third,seventh,twelfth,twenty-fourth hour,serum troponin Ⅰ (CTnI) and creatine kinase isoenzyme (CK-MB)levels at third,seventh,twenty-fourth,forty-eighth hour,hepatic and renal functions at third,twenty-fourth,forty-eighth hour,and electrocardiogram (ECG) were evaluated every 4 hours in 3 days after hospitalization on all patients.The two groups of patients were compared the efficacy and change detection of targets,Results 31 patients (86.11％ ) recovered and 5 patients (13.89％ ) died in Ⅰ group.All 36 cases recovered in Ⅱ group.The recovery rate of Ⅱ group was distinctively higher than that in Ⅰ group (P＜0.05) and the difference was statistically significant (P＜0.05).The average recovery time and the length of hospital stay in Ⅱ group were sharply shorter than those in Ⅰ group (P＜0.01) and the difference was statistically significant (P＜0.05).Serum CTnⅠ levels between seventh hour and forty-eighth hour,serum CK-MB levels between third hour and forty-eighth hour and methemoglobin concentration at third,seventh,twelfth,twenty-fourth hour were apparently lower in Ⅱ group,and the difference was statistically significant (P＜0.05).The abnormal rates of hepatic and renal functions in Ⅱ group were distinctively lower than those in Ⅰ group and the difference was statistically significant (P＜0.05).The abnormal rates of ECG in the second and third day in Ⅱ group were respectively 38.89％ and 11.11％,and were lower than those in Ⅰ group (64.71％、38.71％ ).The difference was statistically significant (P＜0.05).Conclusion Scopolamine has the excellent treatment effect on acute severe chlorphenamidine poisoning patients and protec their hearts,livers,and kidneys.It complements the deficiency of reductant-oxidants,and combination of the two drugs can form the synergy effect.