CAJ | 학술논문

目的观察盐酸戊乙奎醚(长托宁)序贯阿托品治疗重度急性有机磷农药中毒(AOPP)的临床疗效.方法回顾性分析本院2007年1月至2011年8月急救中心收治的180例重度AOPP患者的临床资料.依据抗胆碱药物的选择不同分为长托宁序贯阿托品组、阿托品组、长托宁组,每组60例.分析3组并发症发生率、胆碱酯酶(ChE)活性恢复70％时间、住院时间、住院费用、治愈率、病死率.结果长托宁序贯阿托品组除1例贲门癌术后中毒患者出现中间综合征外,其余患者均无任何并发症,并发症发生率1.67％；患者无死亡,均痊愈出院,治愈率100.00％；ChE活性恢复70％时间为(4.0±1.1)d；住院时间(7.0±2.2)d；住院费用(6268±238)元.阿托品组出现阿托品耐药3例、中间综合征3例、反跳2例、阿托品中毒2例,并发症发生率16.67％;因呼吸、循环衰竭死亡3例,病死率5.00％；治愈57例,治愈率95.00％；ChE活性恢复70％时间为(8.0±0.9)d；住院时间( 12.0±2.1)d;住院费用(7160±110)元.长托宁组出现呼吸衰竭1例、肺水肿1例,并发症发生率3.33％；死亡2例,病死率3.33％；治愈58例,治愈率96.67％；ChE活性恢复70％时间(6.0±0.7)d；住院时间(9.0±1.5)d；住院费用(7921±230)元.与单用阿托品比较,长托宁序贯阿托品组病死率低,疗效高,并发症少,ChE复活快,住院时间短,且住院费用低于单用阿托品和单用长托宁两组,差异均有统计学意义(均P＜0.01).结论长托宁序贯阿托品救治重度AOPP疗效更加显著,不良反应少,住院时间短、费用低.
목적 관찰염산무을규미(장탁저)서관아탁품치료중도급성유궤린농약중독(AOPP)적림상료효.방법 회고성분석본원2007년1월지2011년8월급구중심수치적180례중도AOPP환자적림상자료.의거항담감약물적선택불동분위장탁저서관아탁품조、아탁품조、장탁저조,매조60례.분석3조병발증발생솔、담감지매(ChE)활성회복70％시간、주원시간、주원비용、치유솔、병사솔.결과 장탁저서관아탁품조제1례분문암술후중독환자출현중간종합정외,기여환자균무임하병발증,병발증발생솔1.67％；환자무사망,균전유출원,치유솔100.00％；ChE활성회복70％시간위(4.0±1.1)d；주원시간(7.0±2.2)d；주원비용(6268±238)원.아탁품조출현아탁품내약3례、중간종합정3례、반도2례、아탁품중독2례,병발증발생솔16.67％;인호흡、순배쇠갈사망3례,병사솔5.00％；치유57례,치유솔95.00％；ChE활성회복70％시간위(8.0±0.9)d；주원시간( 12.0±2.1)d;주원비용(7160±110)원.장탁저조출현호흡쇠갈1례、폐수종1례,병발증발생솔3.33％；사망2례,병사솔3.33％；치유58례,치유솔96.67％；ChE활성회복70％시간(6.0±0.7)d；주원시간(9.0±1.5)d；주원비용(7921±230)원.여단용아탁품비교,장탁저서관아탁품조병사솔저,료효고,병발증소,ChE복활쾌,주원시간단,차주원비용저우단용아탁품화단용장탁저량조,차이균유통계학의의(균P＜0.01).결론 장탁저서관아탁품구치중도AOPP료효경가현저,불량반응소,주원시간단、비용저.
Objective To investigate the clinical efficacy of penehyclidine hydrochloride sequential to atropine in severe acute organophosphorus pesticide poisoning ( AOPP ).Methods A retrospective analysis of the clinical data of 180 patients with severe AOPP admitted to the Emergency Center of Wuwei City People's Hospital from January 2007 to August 2011 was conducted.The patients were divided into penehyclidine hydrochloride sequential to atropine group,atropine group and penehyclidine hydrochloride group according to difference of anticholine drugs using,with 60 cases in each group.The complication rate,time of recovery of cholinesterase ( ChE ) activity to 70％,hospital stay time and cost,the cure rate,mortality rate in three groups were analyzed.Results In penehyclidine hydrochloride sequential to atropine group,except for 1 case of cancer of gastric cardia with poisoning after operation showing intermediate syndrome of poisoning,the remaining patients did not have any complication,and the incidence of complications was 1.67％.No death occurred in all the patients,and the cure rate was 100.00％.Time of recovery from ChE activity to 70％ was (4.0 ± 1.1 ) days; hospital stay was (7.0 + 2.2 ) days; hospital expenses were (6268 ± 238 ) yuan.In atropine group,3 patients were found to have atropine resistance,3 patients showed intermediate syndrome,rebound was observed in 2 cases,atropine poisoning in 2 patients,and the incidence of complications was 16.67％.Three patients died of respiratory or circulatory failure,and the mortality rate was 5.00％.Fifty-seven patients were cured,the cure rate was 95.00％.The time of ChE activity recovery to 70％ was (8.0 ± 0.9 ) days.Hospital stay was ( 12.0 ± 2.1 ) days.Hospital expenses were (7160 ± 110) yuan.In penehyclidine hydrochloride group,1 patient was found to have respiratory failure,1 case suffered from pulmonary edema,and the complication rate was 3.33％.Two patients died,the mortality rate wan 3.33％.Fifty-eight patients were cured,the cure rate was 96.67％.The time of ChE activity recovery to 70％ was ( 6.0 ± 0.7 ) days,hospital stay was (9.0 ± 1.5 ) days,and hospital expenses were ( 7921 ± 230 ) yuan.Compared with atropine group,penehyclidine hydrochloride seqnential to atropine group had a low death rate,high cure rate,less complications,ChE activity recover fast,short hospital days,and the hospitalization expenses were lower than that of the single use of atropine or single use of penehyclidine hydrochloride group,and the differences were statistically significant (all P＜0.01 ).Conclusions In treatment of severe AOPP by penehyclidine hydrochloride sequential to atropine,curative effect was more significant,with fewer adverse reactions,short hospital stay,lower cost.