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目的观察阿托品、长托宁不同时机联合治疗重度急性有机磷农药中毒(AOPP)的疗效。方法将89例重度AOPP患者,随机分为开始联合组(43例)和阿托品化联合组(46例)。开始联合组,在开始治疗时阿托品即联合长托宁;阿托品化联合组,先用阿托品达阿托品化后再与长托宁联合,维持阿托品化状态。动态观察胆碱酯酶(CHE)活力,记录阿托品化时间、住院时间和中间综合症、死亡、有机磷中毒反跳、阿托品中毒发生数,分析两组的临床疗效。结果阿托品化联合组与开始联合组比较,阿托品化时间、CHE活力恢复50%时间及住院时间明显缩短[阿托品化时间:(54.6±18.3)min比(65.3±23.1)min,P<0.01,CHE活力恢复时间:(4.2±1.9)d比(5.3±2.6)d,住院时间:(15.1±5.6)d比(18.2±6.8)d,均P<0.05],中毒反跳、阿托品中毒的发生率明显降低(中毒反跳:2.1%比13.9%,阿托品中毒:4.3%比18.6%,均P<0.05)。结论先用阿托品快速达阿托品化后,再用小剂量阿托品、长托宁联合应用维持阿托品化状态治疗重度AOPP,疗效优于开始联合治疗组,可减少并发症的发生,使患者平稳度过危险期,缩短住院时间。
Objective To observe the curative effects of atropine and chatonin on the combined treatment of severe acute organophosphorus pesticide poisoning (AOPP). Methods Eighty-nine patients with severe AOPP were randomly divided into initial combination group (n = 43) and atropine combined group (n = 46). To start the joint group, at the beginning of treatment, atropine that is combined with long-Tuning; atropinization combined group, the first with atropine and then with the long Tuoning after the combination of atropine to maintain the status of atropine. Cholinesterase (CHE) activity was dynamically observed. Atropine time, hospital stay and intermediate syndrome were recorded. The deaths, rebound of organophosphate poisoning and the number of atropine poisoning were recorded. The clinical efficacy was analyzed. Results Compared with the initial combination group, the atropisation time, the 50% recovery of CHE activity and the length of hospital stay were significantly shorter in atropinization combined group (atropinization time: (54.6 ± 18.3) min vs (65.3 ± 23.1) min, P <0.01, CHE The recovery time of vitality was (4.2 ± 1.9) d (5.3 ± 2.6) d, length of hospital stay was (15.1 ± 5.6) days and (18.2 ± 6.8) days, respectively, P <0.05] Significantly lower (poisoning rebound: 2.1% vs 13.9%, atropine poison: 4.3% vs 18.6%, both P <0.05). Conclusions The rapid use of atropine diatomatization, and then a small dose of atropine, penehyclidine combination of atropine to maintain the status of treatment of severe AOPP, the effect is better than the beginning of combination therapy group, can reduce the incidence of complications, so that patients with a smooth risk Period, shorten the hospital stay.