Hu Xue-zhen, Lu Zhong-qiu, Sun Lai-fang, Wang Zheng
Department of Emergency, The Second Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang Province 325027, China.
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2011 May;29(5):378-80.
To investigate the differences of clinical manifestation and therapy of organophosphorus pesticide poisoning (OPP) between oral exposure and occupational exposure in field work.
From July 2007 to July 2010, 85 patients with acute severe OPP were treated in a hospital, which were divided into oral poisoning group (51 cases) and non-oral poisoning group (34 cases). The differences of clinical manifestations, curative effects and prognosis between two groups were compared.
The rates of myoclonus and ataxia in cases with moderate poisoning of oral poisoning group were 86.4% and 90.9%, which were significantly higher than those (50.0% and 55.0%) of non-oral poisoning group (P<0.05 or P< 0.01). The rates of myoclonus, lung fluid and coma in cases with severe poisoning of oral poisoning group were 100.0%, 89.7% and 93.1%, respectively, which were significantly higher than those (71.4%, 64.3% and 50.0%) of non-oral poisoning group (P<0.05). The mean detoxification hours in cases with moderate poisoning and cases with severe poisoning of non-oral poisoning group were (35.0 +/- 6.2) and (45.0 +/- 11.1) hours which were significantly lower than those [(49.0 +/- 7.7) and (77.0 +/- 10.3) hours] in cases with moderate poisoning and cases with severe poisoning of oral poisoning group (P<0.05). In 24, 48 and 72 h after treatment, the cholinesterase (ChE) activities of non-oral poisoning group were higher than those of oral poisoning group (P< 0.05 or P<0.01). The used doses of pyraloxime methylchloride (PAM-Cl) or atropine and the used total dose of atropine in non-oral poisoning group were lower than those in oral poisoning group (P<0.05 or P<0.01).
The clinical manifestation of non-oral poisoning group is different from the clinical manifestation of oral poisoning group due to the high morbidity of OPP occurred at field site in summer. The used doses of atropine and PAM-Cl are less and the ChE activity recovers quickly for non-oral poisoning group.
探讨野外作业中口服中毒与职业性中毒所致有机磷农药中毒（OPP）临床表现及治疗的差异。
2007年7月至2010年7月，某医院收治85例急性重度OPP患者，分为口服中毒组（51例）和非口服中毒组（34例）。比较两组临床表现、疗效及预后的差异。
口服中毒组中度中毒患者肌阵挛和共济失调发生率分别为86.4%和90.9%，显著高于非口服中毒组（50.0%和55.0%）（P<0.05或P<0.01）。口服中毒组重度中毒患者肌阵挛、肺水肿和昏迷发生率分别为100.0%、89.7%和93.1%，显著高于非口服中毒组（71.4%、64.3%和50.0%）（P<0.05）。非口服中毒组中度中毒和重度中毒患者平均解毒时间分别为（35.0±6.2）小时和（45.0±11.1）小时，显著低于口服中毒组中度中毒和重度中毒患者的（49.0±7.7）小时和（77.0±10.3）小时（P<0.05）。治疗后24、48和72小时，非口服中毒组胆碱酯酶（ChE）活性高于口服中毒组（P<0.05或P<0.01）。非口服中毒组氯解磷定（PAM-Cl）或阿托品使用剂量及阿托品总使用剂量低于口服中毒组（P<0.05或P<0.01）。
由于夏季野外作业OPP发病率高，非口服中毒组临床表现与口服中毒组不同。非口服中毒组阿托品和PAM-Cl使用剂量较少，ChE活性恢复较快。
