急性有机磷农药中毒中间综合征30例临床研究.doc

急性有机磷农药中毒中间综合征30例临床研究摘要：目的：探讨急性有机磷农药中毒中间综合征的临床特点和治疗效果。 方法：对30例急性有机磷农药中毒中间综合征患者早期均给予足量氯磷定和阿托品治疗，出现呼吸肌麻痹时经口气管插管，呼吸机辅助呼吸。同时予合理营养支持治疗。 结果：本组30例患者经过积极治疗，25例患者治愈,3例患者死亡，2例患者经济原因放弃治疗。本组患者治愈率为83.3%。 结论：急性有机磷农药中毒合并中间综合征患者应及时发现、早期治疗，合理机械通气可提高患者抢救成功率。 关键词：有机磷中毒 中间综合征 机械通气 Clinical analysis of 30 cases of acute organic phosphorus pesticide poisoning with intermediate syndrome Qiao Lin Abstract:Objective:To investigate the clinical features and treatment effect of intermediate syndrome of acute organophosphate poisoning. Methods:30 cases of acute organic phosphorus pesticide poisoning with intermediate syndrome were treated with sufficient pralidoxime chloride and atropine at prophase, tracheal intubation through mouth was used when respiratory muscle paralsis took place. At the same time the patients were treated with reasonable nutritional treatment. Result:After active treatment, 25 patients were cured,3 patients died, 2 patients gave up treatment for economic reasons. the recovery rate was 83.3%. Conclusion:For the patients of acute organic phosphorus pesticide poisoning with intermediate syndrome, should be discovered in time and treated early, reasonable mechanical ventilation could improve the success rate of rescue. Keywords:Organophosphate poisoning Intermediate syndrome Mechanical ventilation 【中图分类号】R595.4【文献标识码】B 【文章编号】1008-1879(2012)07-0103-02 急性有机磷农药中毒(AOPP)是临床常见的中毒性疾病，而中间综合征（IMS）是AOPP所引起的发生在急性胆碱能危象和迟发性神经病变之间的一组以肌无力为突出表现的综合征［1］，其病情发展迅速，病死率较高。我院对近年收治的30例IMS患者采用机械通气、营养支持及阿托品、氯磷定对症解毒等综合治疗，取得较好疗效，现报道如下。 1 资料与方法 1.1 临床资料。30例IMS患者均为口服有机磷农药中毒，其中男性12例，女性18例；年龄21-67岁，平均年龄（43.2±8.7）岁；两组患者服药量200ml-300ml，中毒到就诊时间4小时-8小时。农药中毒种类：甲胺磷6例，敌敌畏7例，甲拌磷9例，氧化乐果5例，辛硫磷3例。所有患者就诊时均有明显的急性胆碱能危象表现，血清胆碱酯酶显著下降。根据急性有机磷农药中毒分类重度中毒26例，中度中毒4例。所有患者住院过程中均出现抬头困难、屈颈无力、肢体近端肌无力、呼吸肌无力，或出现呼吸幅度减弱、呼吸减慢和不规律。其中7例伴有睁眼无力、张口困难、饮水呛咳、吞咽困难。以上患者发生中间综合征时间是在有机磷农药中毒后的17小时-90小时，平均(29.4±6.7)小时。 1.2 AOPP治疗方法。 1.2.1 监护。全部患者入院后均予心电、无创血压、呼吸频率、经皮血氧饱和度等连续监护。 1.2.2 治疗措施。所有患者给予留置胃管间断洗胃，每4-6小时一次，连续