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救治有机磷农药中毒未出现阿托品化原因分析保德县人民医院（０３６６００）傅文国霍州矿务局中心医院张创克自１９８８年以来，我院共救治有机磷农药中毒者８１例，均用阿托品治疗，其中９例未出现阿托品化，现分析报告如下。临床资料８１例中男２４例，３例未出现阿托品化，女５７例，６例未出现阿托品化；年龄＜３０岁３９例，２例未出现，３０～５０岁２５例，未出现３例，５０岁以上１７例，４例未出现；氧化乐果中毒３２例，未出现者３例，敌敌畏中毒２８例，未出现者３例，１６０５中毒８例，未出现１例，１０５９中毒５例，ｌ例未出现，３９１１中毒４例，未出现１例，敌百虫中毒４例。按《实用内科学》第８版分级标准；轻度１５例，中毒３１例未出现３例，重度３５例，未出现６例。死亡８例中未出现阿托品化３例占３７，５％，其中２例死于阿托品中毒。讨论一部分有机磷农药中毒病人在应用大剂量阿托品甚至中毒致死也不出现阿托品化，分析其原因如下。１．毒物清除不彻底．阿托品化不易表现。主要由于洗胃不彻底，忽视了导泻，故残存于肠道的毒物仍可吸收，阿托品化就不易表现、本组２例，１例洗胃不彻底，１例忽视了导泻。２．重度中毒不出现阿托品化与下列因素有关：①重度有机磷中毒，由于
(036600) Fu Wenguo Central Hospital Huozhou Mining Bureau Zhang Chong Ke Since 1988, our hospital were treated 81 cases of organophosphate pesticide poisoning, were treated with atropine, Of which 9 cases did not appear atropine, the analysis report is as follows. Clinical data 81 cases of 24 males, 3 cases did not appear atropine, 57 females, 6 cases did not appear atropine; age <30 years in 39 cases, 2 cases did not appear, 30 to 50 years in 25 cases, 3 cases did not appear , 17 cases over the age of 50, 4 cases did not appear; 32 cases of omethoate, 3 cases did not appear, dichlorvos poisoning in 28 cases, 3 cases did not appear, 1605 poisoning in 8 cases, 1 without, 1059 poisoning in 5 cases , L cases did not appear, 3911 poisoning in 4 cases, did not appear in 1 case, 4 cases of trichlorfon poisoning. According to the “Practical Internal Medicine” 8th edition grading standards; mild in 15 cases, 31 cases of poisoning did not appear in 3 cases, severe in 35 cases, 6 cases did not appear. 8 cases died of atropine in 3 cases accounted for 37,5%, of which 2 died of atropine poisoning. Discussion Part of the organophosphate pesticide poisoning patients in the application of high-dose atropine or even poisoning does not appear atropine, the analysis of the reasons are as follows. 1. Toxicity is not completely removed. Atropine is not easy to show. Mainly because gastric lavage is not complete, ignoring the catharsis, it remains in the intestine of the poison can still be absorbed, atropine is not easy to performance, the group of 2 patients, 1 case of gastric lavage is not complete, 1 case of neglect of catharsis. 2. Severe poisoning does not appear atropine and the following factors: severe organic phosphorus poisoning, due to