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患儿,男,3个月。被误灌入甲胺磷5ml,0.5h后入院。查体:呼吸56/min,脉搏160/min,昏迷、抽搐,呼吸极度困难,口唇发绀,吐白沫,有大蒜味,两瞳孔如针尖大小,西肺布满湿啰音。全血胆碱酯酶活力30%。诊断:重度甲胺磷中毒伴呼吸衰竭。因昏迷、呼吸困难未能下胃管洗胃。立即吸氧。肌注阿托品0.26mg每10min1次,解磷定100mg+ 生理盐水10ml静脉注射,30min后加注50mg,同时肌内注射洛贝林1mg共2次,地塞米松2mg、安定5mg、速尿10mg,输液。抢救40min病情进一步恶化。考虑系胃内甲胺磷继续吸收所致。即行胃切开洗胃术,用生理盐水共2000ml反复冲洗胃腔,至洗出液清亮无农药味为止。术中术后阿托品用量及注射间隔时间同前,阿托品化后减量并逐渐延长注射
Children, male, 3 months. Was mistaken for Methamidophos 5ml, 0.5h after admission. Physical examination: breathing 56 / min, pulse 160 / min, coma, convulsions, extreme difficulty breathing, lips cyanosis, spit foam, garlic flavor, two pupil size such as the tip of the needle, the lungs covered with wet rales. Whole blood cholinesterase activity 30%. Diagnosis: Severe methamidosis with respiratory failure. Due to coma, difficulty breathing stomach gastric lavage. Oxygen immediately. Intramuscular injection of atropine 0.26mg every 10min1 times, phosphorus solution of 100mg + saline 10ml intravenously, 30min after the injection of 50mg, while intramuscular injection of Lobelin 1mg a total of 2 times, dexamethasone 2mg, stability and 5mg, furosemide 10mg, infusion . Rescue 40min condition worsened. Consider the Department of Methamidophos continue to absorb due to the stomach. Gastric incision open gastric lavage surgery, with a total of 2000ml of normal saline rinse the stomach, to wash the liquid clear pesticide odor so far. Intraoperative postoperative atropine dosage and injection interval with the former, atropine after the reduction and the gradual extension of injection