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1 病例介绍 患儿 男,9岁,主因头痛、呕吐、肌颤、青紫2小时入院。患儿曾于3小时前在喷洒有“敌敌畏”的房间内活动,近2小时出现头晕、头痛、恶心、呕吐、腹痛、多汗及面部全身青紫,在当地医院肌注“阿托品”(剂量不详)后急来我院。既往体健,无心慌、气短、不能平卧史。查体:体温36.3℃、呼吸22次/分、脉搏99次/分、血压12/8 kPa(90/60mmHg)。神清,不能站立,面色、口唇及甲床青紫,有肌颤。双侧瞳孔等大正圆直径约4 mm,对光反射存在。双肺可闻及大、中水泡音。心音有力,律整,无杂音。腹平软,脐周压痛,肝脾未触及。余未见异常。心电图:大致正常。胆碱脂酶20 u。即予吸氧、阿托品0.02 mg/kg、解磷定20 mg/kg静点等处理。患儿病情渐好转,但面色、口唇及甲床无明显改善。再三追问病史,发现患儿于3小时前误将亚硝酸钠作为食盐炒米饭食用,同食者两人均有青紫现象。考虑患儿与有机磷中毒同
1 case description Children male, 9 years old, mainly due to headache, vomiting, fibrillation, bruising 2 hours admission. Children had activity in room sprayed with “dichlorvos” 3 hours earlier and had dizziness, headache, nausea, vomiting, abdominal pain, hyperhidrosis and facial bruising in the last 2 hours. The patients were given “atropine” intramuscularly at a local hospital ) Hurry to our hospital. Past physical health, no palpitation, shortness of breath, can not lie history. Physical examination: body temperature 36.3 ℃, breathing 22 beats / min, pulse 99 beats / min, blood pressure 12/8 kPa (90 / 60mmHg). Clear, can not stand, looking, lips and nail bed purple, with fibrillation. Orthodontic pupil diameter of about 4 mm, the presence of light reflex. Lungs can be heard and large, bubble in water. Heart sound strong, law-abiding, no noise. Abdomen soft, umbilical tenderness, liver and spleen not touched. I no abnormalities. ECG: roughly normal. Cholinesterase 20 u. Namely to oxygen, atropine 0.02 mg / kg, phosphate solution set at 20 mg / kg static point and other treatment. Children get better, but looking, lips and nail bed no significant improvement. Repeatedly asked the medical history and found that children mistakenly sodium nitrite as salt fried rice three hours ago, both with the eater purple phenomenon. Consider children with organophosphate poisoning the same