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目的 分析急性有机磷农药中毒 (AOPP)反跳的原因。方法 44例急性有机磷农药中毒反跳者 ,服毒量 10～2 5 0ml,农药种类 :乐果 6例 ,氧化乐果 3例 ,敌敌畏 7例 ,3 9114例 ,160 5 12例 ,甲胺磷 9例 ,混合性农药 3例 ;轻度中毒 5例 ,中度中毒 19例 ,重度中毒 2 0例。根据以上资料 ,进行抢救。结果 治愈 3 6例 ,死亡 8例。反跳与下列因素有关 :洗胃不彻底 ,未及时清洗污染的皮肤、毛发、衣物 ,残毒再吸收 ,对毒物的种类认识不足 ,抗胆碱能药物减量太快、停药过早 ,在治疗中观察不细致 ,判断阿托品化失误 ,胆碱酯酶复能剂用量不足或过量及治疗用药不当 ,大量快速输入过多液体 ,血中胆碱酯酶复能剂、阿托品浓度被稀释 ,未处理并发症 ,如心律失常、肺水肿、脑水肿等 ,均易致反跳。结论 在AOPP抢救中 ,除彻底清洗消化道、污染的皮肤、毛发及衣物外 ,需正确使用抗胆碱能药物和胆碱酯酶复能剂 ,根据中毒患者各系统的损害全面兼顾 ,综合治疗 ,积极防治并发症 ,提高抢救成功率。
Objective To analyze the reason of the rebound of acute organophosphorus pesticide poisoning (AOPP). Methods Forty-four patients with acute organophosphorus pesticide poisoning were challenged with a dose of 10-250 ml. The pesticide types included 6 cases of dimethoate, 3 cases of omethoate, 7 cases of dichlorvos, 3 9114 cases and 160 5 12 cases of methamidophos 9 cases, mixed pesticides in 3 cases; mild poisoning in 5 cases, moderate poisoning in 19 cases, severe poisoning 20 cases. According to the above information, rescue. Results cured 36 cases, 8 died. Anti-bounce and the following factors: gastric lavage is not complete, did not promptly clean the contaminated skin, hair, clothing, residual reabsorption, lack of understanding of the types of poisons, anticholinergic reduction too fast, withdrawal is too early Treatment is not meticulous to determine the errors of atropine, cholinesterase agent overdose and improper treatment of medication, a large number of rapid infusion of too much liquid, blood cholinesterase agent, atropine concentration was diluted, not To deal with complications, such as arrhythmia, pulmonary edema, cerebral edema, are easy to cause rebound. Conclusion In the rescue of AOPP, in addition to thoroughly cleaning the digestive tract, contaminated skin, hair and clothing, the proper use of anticholinergic drugs and cholinesterase agents, according to the damage of each system of patients with poisoning comprehensive treatment, comprehensive treatment , Active prevention and treatment of complications, improve the success rate of rescue.