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目的探讨急性有机磷农药中毒中间综合征 ( IMS)的发生因素、诊断和治疗。方法对 34例 IMS进行临床分析 ,另设 30例非 IMS的重度急性有机磷农药中毒为对照组 ,比较两组早期使用解毒药剂量及胆碱酯酶活力。结果 IMS和对照组在中毒后第 1天阿托品和复能剂用量比较均有显著性差异 [分别是 ( 2 5 9.8± 82 .4) mg和 ( 196.1± 5 6.9) mg( P<0 .0 5 ) ,( 4.2± 1.4) g和 ( 6.8± 1.7) g( P<0 .0 1)。] IMS发生前 2 4小时内胆碱酯酶均低下 ,并比对照组中毒后 2 4～ 72小时低 ( P<0 .0 5 )。 IMS首发症状多为饮水发呛、声音嘶哑 ,屈颈肌力弱 ,出现呼吸肌麻痹者 ,需及时机械通气和使用复能剂。结论 IMS发生率增加与大剂量阿托品、复能剂用量不足和胆碱酯酶活力低下有关 ,及时机械通气和足量复能剂是治疗 IMS呼吸肌麻痹的关键。
Objective To investigate the occurrence, diagnosis and treatment of acute organophosphorus pesticide poisoning intermediate syndrome (IMS). Methods The clinical data of 34 cases of IMS were analyzed. Another 30 cases of severe acute organophosphorus pesticide poisoning without IMS were set as the control group. The dosage of antidote and the activity of cholinesterase in the two groups were compared. Results The dosages of atropine and vasodilator in the IMS and control groups were significantly different on the first day after poisoning [(25.88 ± 82.4) mg and (196.1 ± 5 6.9) mg (P <0. 5), (4.2 ± 1.4) g, and (6.8 ± 1.7) g (P <0.01). Choline esterase was significantly lower in the 24 hours before IMS onset than in the control group, with a decrease of 24 to 72 hours after poisoning (P <0.05). IMS first symptom is mostly choking water, hoarseness, weak flexion muscle, respiratory muscle paralysis who need timely mechanical ventilation and the use of energy agent. Conclusion The increased incidence of IMS is associated with high dose of atropine, insufficiency of energy agent and low activity of cholinesterase. Timely mechanical ventilation and sufficient energy recovery agent are the key to treatment of respiratory paralysis of IMS.