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目的探讨口服重度急性有机磷农药中毒(SAOPP)患者服毒至救治时间(无治疗期)的长短与患者预后的关系。方法选择经过院前系统救治后接回医院的174例SAOPP患者作为治疗组,自行前往医院或拒绝院前洗胃者160例为对照组。两组治疗方法为洗胃、应用氯磷定、阿托品及对症治疗等综合措施。统计患者无治疗期的长短与死亡、严重并发症的发生情况;观察症状消失时间、全血乙酰胆碱酯酶(AChE)活力恢复至正常时间、阿托品化时间、阿托品用量、氯磷定用量、纳洛酮用量与住院天数等指标。结果治疗组无治疗期时间为(1.2±0.3)h,而对照组为(2.8±0.5)h,差异有统计学意义(P<0.01);治疗组死亡11例(死亡率6.32%),对照组死亡36例(死亡率22.50%),差异有统计学意义(P<0.01);治疗组呼吸衰竭、心脏损害、脑损害、阿托品中毒、中间综合征、肝损害发生率分别为12.64%、5.75%、8.62%、1.72%、4.60%、5.17%,与对照组(25.63%、13.75%、17.50%、6.25%、7.50%、9.38%)的差异有统计学意义(P<0.05或P<0.01);治疗组的中毒症状消失时间、阿托品化时间、AChE恢复至正常时间、阿托品用量、氯磷定用量、纳络酮用量、住院天数各指标均明显优于对照组,差异有统计学意义(P<0.05或P<0.01)。结论院前系统救治可改善SAOPP患者的预后,值得推广应用。
Objective To investigate the relationship between the duration of taking poison and the time of treatment (without treatment) in patients with oral severe acute organophosphorus pesticide poisoning (SAOPP) and the prognosis of patients. Methods One hundred and seventy four SAOPP patients who returned to the hospital after the prehospital system treatment were selected as the treatment group and 160 patients who went to the hospital by themselves or who refused to have gastric lavage before admission were taken as the control group. Two groups of treatment for gastric lavage, application of chlorpromazine, atropine and symptomatic treatment and other comprehensive measures. The duration of patients without treatment and the incidence of serious complications were counted. The symptom disappearance time, the AChE activity of the whole blood returned to normal, the time of atropine, the amount of atropine, the dosage of chlorophosphon, Ketone dosage and hospitalization days and other indicators. Results The duration of no treatment was (1.2 ± 0.3) h in the treatment group and (2.8 ± 0.5) h in the control group, the difference was statistically significant (P <0.01). In the treatment group, 11 patients died (6.32%) There were 36 deaths in the group (mortality 22.50%), the difference was statistically significant (P <0.01). The incidences of respiratory failure, heart damage, brain damage, atropine poisoning, intermediate syndrome and liver damage in the treatment group were 12.64% and 5.75 %, 8.62%, 1.72%, 4.60%, 5.17%, respectively, which were significantly different from those of the control group (25.63%, 13.75%, 17.50%, 6.25%, 7.50%, 9.38% ); The disappearance time of poisoning symptoms, the time of atropineization, the recovery of AChE to normal time, the amount of atropine, the dosage of chlorophosphate, the dosage of naloxone and the days of hospitalization in the treatment group were all significantly better than those in the control group (the difference was statistically significant ( P <0.05 or P <0.01). Conclusion Prehospital system treatment can improve the prognosis of patients with SAOPP, it is worth to promote the application.