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目的探讨对急性有机磷农药中毒并呼吸肌麻痹患者呼吸支持过程中阿托品的合理用量。方法收集2000年6月～2004年6月我院收治的99例急性有机磷农药中毒并呼吸肌麻痹患者的病例资料。按阿托品的不同用量进行阶梯式分组,共分9组。对各组患者的阿托品用量不足及过量中毒的发生率、病死率、阿托品维持时间、呼吸机脱机时间、住院时间进行比较,并进行统计学处理。结果阿托品维持用量在2mg/h 以下者(Ⅰ、Ⅱ组)阿托品用量不足发生率、病死率均高于其它组(P<0.05);阿托品维持用量在2～5 mg/h,维持3～5 d 后逐渐减量直到完全恢复为自主呼吸者(Ⅲ-Ⅵ组)阿托品用量不足及过量中毒发生率、病死率均为0;阿托品维持用量在10～20 mg/h(Ⅶ、Ⅷ组)阿托品维持时间、脱机时间、住院时间相应延长(P<0.05);各组治愈患者氯磷啶应用总量、维持时间无显著差异(P>0.05)。结论急性有机磷农药中毒并呼吸肌麻痹患者行呼吸支持期间,阿托品用量维持在2～5 mg/h 是提高治愈率降低病死率的理想用量。
Objective To investigate the rational dosage of atropine in the respiratory support of patients with acute organophosphorus pesticide poisoning and respiratory muscle paralysis. Methods A total of 99 cases of acute organophosphorus pesticide poisoning and respiratory muscle paralysis admitted from June 2000 to June 2004 in our hospital were collected. According to the different amount of atropine for grouping, divided into 9 groups. Atropine consumption in each group was insufficient and the incidence of over-poisoning, mortality, atropine maintenance time, ventilator offline time, hospital stay were compared and statistically analyzed. Results Atropine maintenance dose of 2mg / h or less (group Ⅰ, Ⅱ) incidence of under-consumption of atropine, mortality were higher than the other groups (P <0.05); atropine maintenance dose of 2 ~ 5 mg / h, maintaining 3 to 5 d and then gradually reduced until fully recovered to spontaneous respiration (Ⅲ-Ⅵ group) atropine lack of dosage and the incidence of over-poisoning, mortality were 0; atropine maintenance dose of 10 ~ 20 mg / h (Ⅶ, Ⅷ) atropine Maintenance time, offline time and hospitalization time were prolonged accordingly (P <0.05). There was no significant difference between the two groups in the total amount of chlorophosphonates used and the maintenance time (P> 0.05). Conclusion Acute organophosphorus pesticide poisoning and respiratory muscle paralysis patients during respiratory support, the amount of atropine maintained at 2 ~ 5 mg / h is to improve the cure rate and reduce the ideal mortality.