测定血液丁酰胆碱酯酶活性在急性有机磷中毒诊治中意义.docVIP

测定血液丁酰胆碱酯酶活性在急性有机磷中毒诊治中意义 　【关键词】 丁酰胆碱酯酶；有机磷中毒；治疗 　　［摘要］ 目的：探讨急性有机磷中毒患者(AOPP)血清丁酰胆碱酯酶(BCHE)在诊断和疗效监测方面的意义。方法：研究组22例患者入院后均给予清除毒物、应用5%碳酸氢钠、复方解磷注射液、氯磷定注射液和阿托品等治疗。分别于治疗前、治疗后1 d、2 d、3 d、4 d、7 d及出院时采静脉血测定血清BCHE活性。以180例本院健康体检者作为正常对照组。结果轻、中、重度中毒患者血清BCHE活性，在服毒后较正常对照组明显降低(P＜0.01)，但在治疗血清BCHE并无升高，治疗4 d后血清BCHE有升高(Plt;0.005)，但仍远低于正常对照组。三组患者在治疗过程中，血清BCHE数据表现出较大的离散性。即使在同一治疗组中，各患者服毒后BCHE下降的幅度相差也较大，甚至出现了跨组别的交叉。结论：血清BCHE活性与患者的症状和体征相关性较差。胆碱酯酶活性测定对于AOPP的最大意义在于确认病因。 　　［关键词］ 丁酰胆碱酯酶；有机磷中毒；治疗 　　Determining the Serum Butyrylcholinerase in Patients with Acute Organophosphorous Poisoning by a Rate Method on Automatic Analyser 　　Abstract：Objective To investigate the prognostic value of serum butyrylcholinesterase levels and their values in monitoring the clinic course in acute organophosphate poisoning.Methods Twentytwo patients with acute organophosphate poisoning were evaluated.Patients were assessed at admission time according to symptoms,results of clinical exams and their serum butyrylcholinesterase levels were determined on days 1,2,3,4,7,and the last day.Serum BCHE were quantified according to Knedel et al.Results There was significant difference between the firstday serum butyrylcholinesterase of the patients with poisoning and of the normal control cases.There was no discernible difference between the serum butyrylcholinesterase on days 1 and 3 after poisoning.There was a significant difference between the serum butyrylcholinesterase levels obtained on days 1 and the 7th day.Conclusion In the acute organophosphate poisoning,low serum butyrylcholinesterase(gt;40% of minimum normal value)supports the diagnosis of organophosphate poisoning but it does not show a significant relationship to the severity of poisoning. 　　Key words：Cholinesterase；Poisoning；Organophosphorus 　　有机磷化合物(organophosphorus compounds)中毒是中毒事件中较为常见的，胆碱酯酶活性测定是在诊断有机磷中毒中公认的有效实验室依据。有作者认为测定全血或红细胞ChE活性值较单纯测定血清ChE更有意义［1］。我们在日立全自动生化分析仪上用Knedel方法测定了22例急性有机磷中毒患者(acute organophosphorus poisoning,AOPP)血清丁酰胆碱酯酶(butyrylcholinesterase,B