患者,男,36岁,因有机磷农药中毒,给予静滴解磷定及半流饮食,阿托品5mg每30分钟肌注1次,4小时后病人达阿托品化,出现烦躁,口干,T38℃,双瞳6mm,等大等圆,光反射减弱,皮肤潮红,心率130次/分,(阿托品总量为40mg)。立即将阿托品减量维持,上述症状逐渐减轻。第六日晚7时,阿托品已减至1mg每3小时肌注一次,总量为238mg,病人出现腹胀、腹痛,呕吐黄绿色液体,肛门停止排气排便。查体:(-),心率110次/分,腹部膨隆,全腹压痛、反跳痛、肌紧张,移动性浊音(+),未扪及包块,肝浊音界存在,肠鸣消失,腹腔穿刺抽出黄绿色液体。初步考虑为胆囊穿孔,全腹膜炎,急转外科行剖腹探查术,术中见胃极度扩张,胃大弯达耻骨联合上4cm处,张力高,胃内抽出黄绿色液体约3000ml,同时见胆囊充盈积 Patients, male, 36 years old, due to organophosphorus pesticide poisoning, given intravenous dipropionate and half-flow diet, atropine 5mg intramuscular injection once every 30 minutes, 4 hours after the patient dainto drugification, irritability, dry mouth, T38 ℃ , Double pupil 6mm, such as large round, light reflex, skin flushing, heart rate 130 beats / min, (atropine total 40mg). Immediate reduction of atropine to maintain the above symptoms gradually reduced. 7 o’clock on the 6th night, atropine has been reduced to 1mg every 3 hours intramuscular injection, a total of 238mg, the patient had abdominal distension, abdominal pain, vomiting yellow-green liquid, anal stop defecation. Examination: (-), heart rate 110 beats / min, abdominal bulging, total abdominal tenderness, rebound tenderness, muscle tension, mobility dullness (+), palpable mass, Puncture out of the yellow-green liquid. Initial consideration for the gallbladder perforation, all peritonitis, acute surgical laparotomy, surgery to see the extreme expansion of the stomach, pubic symphysis pubic symphysis 4cm Department, high tension, the stomach out of yellow-green liquid about 3000ml, while see the gallbladder filling product