精品29例急性有机磷农药中毒患者血浆胆碱酯酶变化的临床分析.docVIP

29例急性有机磷农药中毒患者血浆胆碱酯酶变化的临床分析 有局限性,但其动态变化对判断病情及预后却具有重要的意义, 即血浆胆碱酯酶活力恢复越快,病情恢复越快,病程越短,预后 越佳。 血浆胆碱酯酶活力测定不仅可判断病情及预后,还可提示残余 毒物是否被彻底清除。本观察显示在同一中毒程度组的患者中, 入院时、24h、48h、72h血浆胆碱酯酶活力差异具有显著性,即治 疗后各组血浆胆碱酯酶活力均迅速回升。根据该结果我们认为在 遇到血浆胆碱酯酶活力持续不恢复的患者,应注意查找原因,尤其注意是否有残余毒的存在。为彻底清除毒物,目前我们主张不 仅应彻底洗胃、清洗皮肤及导泻,对中、重度中毒患者还应重复 洗胃。 复能剂是急性有机磷农药中毒治疗的核心药物之一,但现在临 床上对复能剂的应用较混乱,尤其在基层医院还存在片面强调抗 胆碱药物的应用,而忽视复能剂合理使用的现象。在我们观察的 29例患者中有 3例口服 100毫升乐果的患者,其血浆胆碱酯酶入 院时均明显降低,其增长速度随在基层医院治疗时间的延长而逐 渐降低。由此我们感到复能剂未及早使用或使用剂量不足,致胆 碱酯酶活力未及时恢复是制约急性有机磷农药中毒治疗的关键。 本文结果显示虽然血浆胆碱酯酶活力仅占全血胆碱酯酶活力 的 16%,但其动态变化对病情及预后的判断具有重要意义,并且还 可以指导复能剂的应用和监测残余毒物的清除。监测血浆胆碱酯 酶活力的变化可以指导急性有机磷农药中毒的治疗,使急性有机 磷农药中毒患者的病程缩短,减少并发症的发生,提高治愈率, 降低病死率。关键词:急性有机磷农药中毒血浆胆碱酯酶活力 Abstract Organophosphorus pesticides are the most common classes involved in poisoning pesticides. Cholinesterase being inhibited is the main mechanism of acute Organophosphorus pesticides poisoning AOPP. The aim of this paper is to study the chang of plasma cholinesterase and its clinical significance in AOPP. 29 patients who were cured with AOPP were enrolled in this study. There patients were divided into mild, moderate and severe groups by clinical manifestations. Their plasma cholinesterase were measured upon hospitalization and 24h , 48h, 72h after hospitalization The data of the change of plasma cholinesterase activity of 29cured patients with AOPP are processed by analysis of variance. It has been shown that the changes of plasma cholinesterase activity of three groups were no significant difference at hospitalization. But significant difference of plasma cholinesterase was found after hospitalization. So plasma cholinesterase activity at hospitalization can not reflect the severity of AOPP. But its consequent change correlated with the severity of AOPP, and can be used as clinical indicator of patient’s condition and prognosis The previous study shown that plasma cholinesterase in the mild and moderate/severe groups dropped to the lowest level respectively at 12h and