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目的分析重度有机磷农药中毒致中间型综合征的临床特点及救治经验。方法回顾性分析24例中间型综合征患者的症状、体征及使用阿托品、长托宁、解磷定、盐酸纳洛酮等药物治疗及机械通气等的治疗效果。结果24例中治愈21例,治愈患者以颅神经障碍最早恢复,其次是屈颈肌和四肢肌肉,呼吸肌恢复最晚。于中毒后3~6d死亡3例,均在自主呼吸停止后行紧急气管插管及机械通气,其中1例来诊时呼吸微弱,面部紫绀,出现心跳骤停,经积极抢救,心脏复苏成功,但因合并消化道出血,多器官功能衰竭死亡,2例因肺部感染严重,再次心跳骤停死亡。结论中间型综合征病程有自限性特点,早开通气道,机械通气支持是抢救成功的关键。
Objective To analyze the clinical characteristics and treatment experience of intermediate syndrome caused by severe organophosphorus pesticide poisoning. Methods A retrospective analysis of 24 patients with intermediate syndrome symptoms and signs and the use of atropine, penehyclidine, phlodropine, naloxone hydrochloride and other drug treatment and mechanical ventilation and other therapeutic effect. Results Twenty-one patients were cured in 21 cases. The cured patients recovered with cranial nerve dysfunction as early as possible, followed by those with flexing and extremity muscles. The resuscitation was the latest. 3 to 6 days after the death of poisoning in 3 cases, were in spontaneous respiration after the end of emergency endotracheal intubation and mechanical ventilation, one case to visit the diagnosis of weak breathing, facial cyanosis, a sudden cardiac arrest, after active rescue, cardiac resuscitation success, However, due to the merger of gastrointestinal bleeding, multiple organ failure, 2 cases of serious pulmonary infection, cardiac arrest and death again. Conclusion The course of middle syndrome has the characteristics of self-limiting. Early airway and mechanical ventilation support are the keys to successful rescue.