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目的 探讨肟类药物对氨基甲酸酯 (CB)类农药与有机磷杀虫剂 (OP)混配中毒的疗效。方法 对收治的 11例急性单纯CB(灭多威 )及其与OP等其他农药混配中毒的患者进行临床观察、实验室检查 [包括全血胆碱酯酶 (ChE)活力测定 ]及治疗。患者入院后彻底清洗污染的皮肤或洗胃 ,并给予阿托品 (At)和肟类药物治疗及对症处理。根据病情轻重 ,At首剂用量为 1～ 10mg ,总用量为 6.4～10 1.0mg;肟类药物除 2例用碘解磷定外 ,其余均给予氯解磷定治疗 ,用量 0 .5～ 3 0 .0g。结果 所有患者治疗后急性胆碱能兴奋或危象的症状和体征逐渐减轻和消失 ,用肟类药物者未见明显的不良反应 ,5例中、重度中毒患者在给予氯解磷定治疗后 3～ 2 4h内肌束震颤消失。绝大多数患者全血ChE活力恢复到正常水平 ( 87%～ 10 1%)。全部患者住院 2～ 8d ,痊愈出院。结论 急性灭多威与OP混配中毒 ,可用足量At并谨慎使用肟类ChE复能剂治疗。氯解磷定对急性中、重度OP与CB混配中毒患者出现的烟碱样症状有较好的疗效。
Objective To investigate the effect of oximes on the poisoning of carbamates (CB) and organophosphate insecticides (OP). Methods Clinical observation, laboratory tests [including whole blood cholinesterase (ChE) activity assay] and treatment were performed in 11 patients with acute simple CB (methomyl) and other pesticides mixed with OP. Patients were thoroughly cleaned after admission contaminated skin or gastric lavage, and given atropine (At) and oxime drugs and symptomatic treatment. According to the severity, At first dose of 1 ~ 10mg, the total amount of 6.4 ~ 10 1.0mg; oxime drugs in addition to 2 cases of iodine-phosphorous, the rest were given chlorpromazine treatment, the amount of 0.5 ~ 3 0 .0g. Results After treatment, symptoms and signs of acute cholinergic excitement or crisis were gradually reduced and disappeared in all patients. No obvious adverse reactions were observed with oximes. After treatment with chlorpheniramine, 5 patients with moderate to severe poisoning ~ 2 4h muscle bundle tremor disappeared. The vast majority of patients with whole blood ChE vitality returned to normal levels (87% ~ 101%). All patients were hospitalized 2 ~ 8d, recovered and discharged. Conclusion Acute methomyl mixed with OP poisoning, available enough At and careful use of oxime class ChE agent. Clopidogrel fixed in acute, severe OP and CB mixed poisoning patients with nicotinic-like symptoms have a good effect.