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目的:探讨氯磷定对不同途径有机磷中毒胆碱酯酶活力恢复情况。方法:分析2008年1月-2013年1月接受治疗的急性有机磷中毒患者的临床资料。依据患者中毒途径不同将患者分为皮肤组(33例)、口服组(42例);另选取30例健康体检者作为对照组。结果:入院时,皮肤组、口服组轻度、口服组中度及口服组重度患者血清ChE水平均显著低于对照组患者,相比较差异均具有统计学意义(P<0.05)。口服组在入院后第2,3,4,5天时的血清ChE水平均显著高于皮肤组(P<0.05)。口服组血清ChE平均升高速率显著高于皮肤组(1.28±0.17 vs 1.05±0.09;t=10.090,P<0.001)。入院第1,2,3,4天时,皮肤组中毒指数(共8分,分数越大表示患者中毒程度越重)显著低于口服组,相比较差异具有统计学意义(P<0.05);入院5 d时,2组患者中毒指数相比较差异无统计学意义(t=1.702,P=0.093)。结论:急性有机磷中毒的救治中,血清ChE在判断经口中毒患者的疗效及预后上较佳。但经皮肤途径中毒的患者血清ChE的恢复滞后于临床症状的改善,因而用血清ChE判断其疗效有欠缺。
OBJECTIVE: To investigate the recovery of cholinesterase activity by organophosphorus pesticide poisoning in different ways. Methods: The clinical data of patients with acute organophosphate poisoning who were treated from January 2008 to January 2013 were analyzed. The patients were divided into skin group (33 cases) and oral group (42 cases) according to different pathways of poisoning. Another 30 healthy subjects were selected as control group. Results: On admission, the serum ChE levels in skin group, oral group and moderate oral group as well as severe oral group were significantly lower than those in control group (P <0.05). The level of serum ChE in the oral group was significantly higher than that in the skin group on the 2nd, 3rd, 4th and 5th days after admission (P <0.05). The average rate of increase of serum ChE in oral group was significantly higher than that in skin group (1.28 ± 0.17 vs 1.05 ± 0.09; t = 10.090, P <0.001). On the 1st, 2nd, 3rd and 4th day of admission, the poisoning index of the skin group (a total of 8 points, the bigger the score was, the more severe the patient’s poisoning degree) was significantly lower than the oral group, with statistical significance (P <0.05) At 5 days, there was no significant difference in the toxic index between the two groups (t = 1.702, P = 0.093). Conclusion: In the treatment of acute organophosphate poisoning, serum ChE is better in judging the efficacy and prognosis of patients with oral toxicity. However, the recovery of serum ChE in patients who have been poisoned by percutaneous route lags behind the improvement of clinical symptoms. Therefore, the determination of serum ChE is ineffective.