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患者,男,34岁,6天前因外阴部瘙痒难忍,自用农药甲胺磷原液涂洗,浸泡阴茎、阴囊等部位数分钟,约1小时后出现头晕、呕吐,伴全腹绞痛,解黄色烂便,大汗,面色苍白,3小时后急诊入院。经用胆碱酯酶复能剂及阿托品等治疗,病情明显好转,上述症状消失,一般情况良好。病程第5天突然出现呼吸困难,呼吸3～4次/min,神志不清,即行气管内插管,机械通气辅助呼吸。30分钟后自主呼吸完全消失。查体:T 37.8℃,BP100/80 mmHg,自主呼吸消失,浅昏迷状态,双侧瞳孔直径2.5mm,双肺可闻及少许痰鸣音,未闻及干湿性罗音。阴茎冠状沟内可见少许颗粒状凸起,余未见特殊。胆碱酯酶活力测定为35u/L,考虑急性有机磷中毒并中间综合征。经阿托品静滴,呼吸机辅助呼吸,反复清洗外阴部等治疗,1小时后神志转清,并出现微弱自主呼吸,5小时后自主呼吸明显好转。19小时后自主呼吸有力、平整,故停用呼吸机。观察24小时病情无恶化后拔除气管插管。2周后痊愈出院,随访3
Patients, male, 34 years old, 6 days ago due to genital itching unbearable, self-use pesticide methamidophos stock solution Tu, soaked penis, scrotum and other parts for a few minutes, about 1 hour after dizziness, vomiting, with total abdominal cramps, Solutions yellow rotten, sweating, pale, 3 hours after emergency admission. After treatment with cholinesterase agent and atropine, the condition improved significantly, the above symptoms disappeared, the general situation is good. The first five days of course of sudden breathing difficulties, breathing 3 to 4 times / min, unconscious, that endotracheal intubation, mechanical ventilation assisted breathing. After 30 minutes spontaneous breathing disappeared completely. Examination: T 37.8 ℃, BP100 / 80 mmHg, spontaneous respiration disappeared, shallow coma state, bilateral pupil diameter 2.5mm, both lungs can be heard and a little phlegm, no smell and wet and dry rales. Coronal penis seen a little granular bulge, Yu no special. Cholinesterase activity was determined as 35u / L, consider acute organophosphate poisoning and intermediate syndrome. After intravenous infusion of atropine, ventilator-assisted breathing, repeated cleaning of the genitals and other treatment, 1 hour after the consciousness clear, and weak spontaneous breathing, 5 hours after spontaneous breathing significantly improved. 19 hours after spontaneous breathing, formation, it disables the ventilator. Observed 24 hours after the removal of the disease without deterioration of the tracheal intubation. After 2 weeks, he was discharged and followed up