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患者,男,22岁,因喝农药(敌敌畏)50 ml后1 h入院。入院查体:体温35.4℃,脉搏120次/min,血压150/120 mm Hg。神志不清,呼气大蒜臭味,针尖样瞳孔,无明显肌肉震颤,无流涎,无多汗,无呼吸困难及呕吐,无全身抽搐,肺部无明显干湿性罗音,胆碱脂酶0～15 u。初步诊断:急性有机磷中毒。立即给予清水洗胃,量约24 000 ml,静推阿托品5 mg/5 min,10%葡萄糖500 ml,解磷啶1 g,糖盐水500 ml静滴,10 min后瞳孔变大,但未出现烦躁现象。而后阿托品增至15 mg/10 min、30 mg/10min、40 mg/10 min,大量输液,维持酸碱平衡、利尿等,次日出现血尿,一天后尿转清,第4 d晚上9点出现明显烦燥、颜面潮红、
The patient, male, 22 years old, was hospitalized 1 h after drinking 50 ml of pesticide (dichlorvos). Admission examination: body temperature 35.4 ℃, pulse 120 beats / min, blood pressure 150/120 mm Hg. Unconscious, exhaled garlic odor, needle-like pupil, no significant muscle tremors, no salivation, no sweating, no breathing difficulties and vomiting, no systemic convulsions, lung no obvious wet and dry rales, cholinesterase 0 ~ 15 u. Preliminary diagnosis: acute organophosphate poisoning. Immediately give clean water gastric lavage, the amount of about 24 000 ml, atropine 5 mg / 5 min, 10% glucose 500 ml, phosphogypsum 1 g, 500 ml intravenous infusion of saline, pupil 10min larger, but did not appear Irritability. And then atropine increased to 15 mg / 10 min, 30 mg / 10min, 40 mg / 10 min, a large infusion, maintaining acid-base balance, diuretic, hematuria the next day, one day urine clear, the first 4 d 9 o’clock Obviously irritable, facial flushing,