有机磷中毒一例

有机磷高氯辛硫磷农药中毒一例,SICU 徐凯,病例资料,崔某某，男，19岁主诉：口服“高氯辛硫磷”后呼吸困难、呕吐2小时现病史：患者2小时口服“高氯辛硫磷”约100ml后，逐渐出现呼吸困难、呕吐，伴有胸闷气短，无腹痛、无腹泻、无大小便失禁，有肌肉抽动。,急诊血常规、离子、胆碱酯酶,血常规：白细胞16.67109/L钾离子：3.37mmol/L血胆碱酯酶（ChE）1190U/L,诊断,急性有机磷农药中毒（acute organophosphorus pesticides poisoning,AOPP）,高氯辛硫磷,2-氯-N-二乙氧基硫代膦酰氧基苯甲亚氨基腈分子式 C12H14CLN2O3PS分子量 332.74,治疗,1、洗胃、导泻、胃肠减压2、阿托品化3、碘解磷定解毒，检测血胆碱酯酶（ChE）4、CVVHD+HP PP,CVVHD+HP,连续性血液透析滤过+血液灌流,调整CRRT治疗模式,血浆灌流(plasma perfusion,PP),血小板下降,ChE水平监测,碘解磷定剂量调整,碘解磷定减量与胆碱酯酶检测水平的关系,凝血改变,患者在较低肝素维持量下,冲洗回收血浆灌流器残存血浆,文献复习1,Liang M.J., Zhang Y. ，etc：Clinical analysis of penehyclidine hydrochloride combined with hemoperfusion in the treatment of acute severe organophosphorus pesticide poisoning. J.Genetics and Molecular Research. 14 (2) (pp 4914-4919), 11，May，2015.,penehyclidine hydrochloride，PHC ，长托宁，盐酸戊乙奎醚,Abstract:,This study aimed to observe the clinical curative effect of penehyclidine hydrochloride (PHC) combined with hemoperfusion in treating acute severe organophosphorus pesticide poisoning. We randomly divided 61 patients with severe organophosphorus pesticide poisoning into an experimental group (N = 31) and a control group (N = 30), and we compared the coma-recovery time, mechanical ventilation time, healing time, hospital expenses, and mortality between the two groups. The coma-recovery time, mechanical ventilation time, and healing time were lower in the experimental group than in the control group (P 0.05), while the hospitalization expenses were higher in the experimental group than in the control group (P 0.01); moreover, no significant difference was observed in the mortality rate between the two groups. Thus, PHC combined with hemoperfusion exerts a better therapeutic effect in acute severe organophosphorus pesticide poisoning than PHC alone.,2,Fleisher JH,Howard JW,Corrigan JP. Effect of pyridine aldoximes on response of frog recrus muscle to AchE. Brit J Pharmacol and Chem, 1958; 13(3):288 90De Jong LPA,Wolring GZ. Inhibition of acetylcholinesterase by N-alkypridinium-2-aldoxime salts. Groat Chem Acta, 1975;47(3):383 91Ganendran A. Pralidoxime as an insignificant reactivator in severeanticholinesterase(Org.)poisoning. Southeast Asian. J Trop Med Public Health, 1976;7(4):