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目的 了解急性混配农药中毒的临床表现特点 ,以提高混配农药中毒的诊治水平。方法 在 3个县市级医院 ,对 78例急性混配农药中毒患者进行临床观察和诊治研究。结果 分别观察急性口服和生产性混配农药中毒 3 7和 4 1例 ,其中有机磷杀虫剂 (OP)与OP混配 3 0例 (OP +OP组 ) ;OP与拟除虫菊酯杀虫剂 (PY)混配 2 3例 (OP +PY组 ) ;OP与氨基甲酸酯杀虫剂 (CB)混配 8例 (OP+CB组 ) ;OP与其他农药混配 12例 (OP +其他组 ) ;CB与PY或其他农药 (不包括OP)混配 5例 (CB +PY或其他组 )。 5组患者均有不同程度的急性胆碱能兴奋或危象的临床表现 ,尤以头晕、乏力、多汗、流涎、恶心、呕吐、瞳孔缩小、肌束震颤多见 ,重者出现昏迷、肺部湿 口罗音、大小便失禁 ;全血胆碱酯酶(ChE)活力均下降 ( 11%～ 73 %) ,在急性中毒 1～ 4d胆碱能危象基本控制后 ,OP +OP及OP +PY组中5例出现屈颈肌与四肢近端肌肉及颅神经支配的肌肉无力 ,其中 3例出现呼吸肌无力 ,需进行机械呼吸。参照相关诊断标准及分级建议 ,诊断为急性轻度、中度和重度混配农药中毒 3 1、3 0和 17例 ,其中合并轻型“中间期肌无力综合征 (IMS)”2例、重型IMS 3例。经彻底洗胃和清洗污染的皮肤 ,给予解毒药阿托品和氯解磷定、碘解磷定以及对症和支持治疗 ,除OP +OP
Objective To understand the clinical characteristics of acute mixed pesticide poisoning in order to improve the diagnosis and treatment of mixed pesticide poisoning. Methods In three county-level hospitals, 78 patients with acute mixed pesticide poisoning were investigated clinically and diagnosed and treated. Results Acute oral and productive mixed pesticide poisoning were observed in 37 and 41 cases, respectively, in which 30 cases were treated with OP and OP (OP + OP group). OP and pyrethroid insecticides (OP + PY group); 8 (OP + CB group) with OP and carbamate insecticide (CB); 12 patients with OP and other pesticides (OP + other Group); CB and PY or other pesticides (excluding OP) mixed with 5 cases (CB + PY or other groups). 5 groups of patients have different degrees of clinical manifestations of acute cholinergic excitement or crisis, especially in dizziness, fatigue, hyperhidrosis, salivation, nausea, vomiting, miosis, muscle tremors more common in severe coma, lung Department of wet mouth rales, incontinence; cholinesterase (ChE) activity decreased (11% ~ 73%), acute poisoning in 1 ~ 4d cholinergic crisis basic control, OP + OP and OP In 5 cases of PY group, muscle weakness was found in the muscle of the proximal and extremities and the innervation of the cranial nerves in 5 cases, of which 3 cases had respiratory muscle weakness and needed mechanical respiration. According to the relevant diagnostic criteria and grading recommendations, 3 1,3 0 and 17 acute mild, moderate and severe mixed pesticide poisoning cases were diagnosed. Among them, 2 cases were complicated with mild “myasthenia gravis syndrome” (IMS), 2 cases with heavy-duty IMS 3 cases. After thorough gastric lavage and cleaning of contaminated skin, given detoxification atropine and chlorpromazine, iodine and phosphorus set and symptomatic and supportive treatment, in addition to OP + OP