摘要:
目的 分析有机磷农药中毒致呼吸功能衰竭患者的急救措施与临床疗效, 探讨有机磷农药中毒致呼衰患者急救对策, 提升患者治疗预后水平.方法 选取2014年1月至2016年12月南充市中心医院急诊科收治的重症有机磷农药中毒致呼吸功能衰竭患者86例作为研究对象, 按照就诊顺序将患者编号, 采用数字随机表法将患者分为对照组和观察组, 每组43例.所有患者就诊后均予以常规急救措施 (洗胃、气管插管、补液、对症支持治疗) , 对照组患者予以氯磷定注射液和阿托品注射液解毒, 观察组患者予以氯磷定联合盐酸戊乙奎醚注射液解毒.比较2组患者给药后10 min、30 min临床症状改善情况、胆碱酯酶活力 (CHE) 变化及呼吸功能 (呼吸频率、Pa02、Pa02/Fi02) 改善情况, 统计2组患者阿托品化时间、血液净化治疗率、气管切开率、住院治疗时间、死亡率、并发症情况并比较.结果 2组患者性别、年龄、体重、体质量指数 (BMI) 、中毒程度、有机磷中毒药物类别、就诊时血液胆碱酯酶活力 (CHE) 、临床症状等指标比较差异无统计学意义 (P>0.05) .治疗后10min、30 min, 2组患者血液CHE均得到有效提升, 但观察组患者明显高于对照组患者, 组间比较差异有统计学意义 (P<0.05) .2组患者给药后10 min、30 min临床症状率均较入组时明显降低 (P<0.05) , 但观察组患者临床症状率明显低于对照组 (P<0.05) .2组患者给药后10 min、30 mi呼吸功能指标 (呼吸频率、Pa02、Pa02/Fi02) 均较治疗前明显改善 (P<0.05) .观察组患者血液净化治疗率、气管切开率、并发症率明显低于对照组 (P<0.05) , 住院时间、阿托品化时间明显低于对照组 (P<0.05) .但2组患者死亡率比较差异无统计学意义 (P>0.05) .结论 在有效呼吸、循环支持治疗的基础上, 予以盐酸戊乙奎醚联合氯磷定解毒, 可有效恢复有机磷农药中毒患者的胆碱酯酶活力, 改善患者呼吸功能, 提升预后, 具有较高的临床价值.
Abstract:
Objective To improve the prognosis among patients with respiratory failure poisoned by organophosphorus pesticide though analyzing and discussing the emergency measures and treatment effects. Me thods From January 2014 to December 2016, 86 patients with respiratory failure caused by severe organophosphorus pesticide poisoning were received in the Emergency Department in Nanchong Central Hospital.The patients were numbered according to the order of the treatment and randomly divided into control group and observation group with43 cases in each group.All patients were treated with routine emergency measures (gastric lavage and endotracheal intubation, rehydration, and symptomatic treatment) .The control group was treated with pralidoxime chloride injection and injection of atropine detoxification while the observation group was given pralidoxime chloride combined with Penehyclidine Hydrochloride Injection detoxification.We compared the alleviation of clinical symptoms and the changes of cholinesterase (CHE) and respiratory function (respiratory frequency, Pa02, Pa02/Fi02) between the two groups of patients 10 min and 30 min after administration. The statistics of atropinization time, blood purification treatment rate, tracheotomy rate, hospital mortality, complications and treatment time were recorded.Re s ults No statistic significance was observed among the two groups of patients in gender, age, weight, body mass index (BMI) , the severity of poisoning, types of organophosphorus drugs and blood cholinesterase (CHE) at the first visit (P > 0.05) .Blood CHE was effectively improved among the two groups 10 min and 30 min after the treatment and significantly higher CHE was seen in the observation group compared to the control group (P <0.05) . The overall clinical symptom rate was lower 10 min and 30 min after the treatment (P < 0.05) , and the clinical symptom rate of the observation group was lower than that of the control group (P < 0.05) . The respiratory function indexes (respiratory rate, Pa02, Pa02/Fi02) were significantly improved 10 min and 30 min after the treatment in both groups compared with those before the treatment (P < 0.05) .The blood purification treatment rate, tracheotomy rate, complication rate, hospitalization time and atropine time of the observation group were significantly lower than those of the control group (P < 0.05) . No significant difference was found in mortality rate between the two groups (P >0.05) .Conclus ion After giving effective respiration and circulation support, administration of penehyclidine hydrochloride combined with pralidoxime chloride detoxification can effectively restore the cholinesterase activity among patients with organophosphorus pesticide poisoning and improve respiratory function and prognosis, whichshows a high clinical value.
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