李健

[摘要] 目的 探讨并分析院前急救在改善有机磷农药中毒患者预后结局中的应用。 方法 从我院2013年6月～2015年6月收治的有机磷农药中毒患者中选取入院前未接受任何急救处理的40例患者作为对照组，在入院途中接受院前急救处理的40例患者作为试验组。比较两组患者药物使用情况、CHE活力恢复时间、并发症发生率及预后情况。 结果 试验组患者阿托品化时间、CHE活力恢复到50%和70%所需时间依次为（2.2±0.8）h、（33.5±6.8）h、（98.4±19.6）h，阿托品化时用量、氯解磷定用量分别为（51.2±9.6）mg、（12.3±2.6）g，时间和药物用量明显少于对照组；试验组患者并发症发生率、总死亡率明显低于对照组，试验组患者的治愈率明显高于对照组，且患者平均住院时间明显少于对照组，两组差异具有统计学意义（P<0.05）。 结论 对于有机磷农药中毒的患者，在入院前对其进行院前急救，不仅可以减少解毒剂药物的使用量，也可以降低并发症的发生率和死亡率，有效缩短患者住院时间，对患者的预后具有积极作用。

[关键词] 院前急救；有机磷农药中毒；预后结局；应用效果

[中图分类号] R595.4 [文献标识码] B [文章编号] 1673-9701（2016）16-0081-03

[Abstract] Objective To discuss and analyze the pre-hospital first aid application in improving the prognosis ending of patients with organophosphorus pesticide poisoning. Methods A total of 40 patients with organophosphorus pesticide poisoning， which admitted in our hospital from June 2013 to June 2015， were selected as the research objects. 40 patients before the hospital without any emergency treatment were set as control group； the remaining 40 patients with pre-hospital emergency treatment on the way to hospital were set as the experimental group. Drug usage， CHE energy recovery time， complications and prognosis of the two groups were compared. Results The experimental group atropine time， CHE time needed for energy recovery to 50% and 70% was（2.2±0.8） h， （33.5±6.8） h， （98.4±19.6） h， atropine dosage， pralidoxime chloride dosage（51.2±9.6） mg， （12.3±2.6） g respectively， which was significantly less than the control group. Complication rates and total mortality of experimental group was significantly lower than the control group； cure rate of experimental group was significantly higher than the control group and the average length of hospital stay and patients was significantly less than the control group， the difference was statistically significant（P<0.05）. Conclusion For patients with organophosphorus pesticide poisoning， pre-hospital first aid not only can reduce the antidote drug use， but also can reduce the incidence of complications and mortality， effectively shorten the length of hospital stay， which have positive role to the prognosis of patients.

[Key words] Pre-hospital first aid； Organophosphorus pesticide poisoning； Prognostic outcomes； Application effect

有机磷农药进入人体后，会对中毒患者的神经系统造成损害，是临床上一种急重病症，有机磷农药会与人体内的胆碱酯酶（cholinesterase，CHE）结合，使CHE活性丧失，从而引起神经功能的紊乱，并且会阻碍患者的呼吸，威胁患者的生命[1]。有研究表明，全世界每年有机磷农药中毒患者有数百万人，患者一旦中毒如果救治不及时死亡率较高，而患者死亡原因多与当地医疗急救水平有直接关系。有机磷农药还会对患者心脏造成损害，使患者出现心率失常。并且农药进入人体药效发挥极快，患者得不到救治会造成神经功能紊乱、呼吸功能衰竭而死亡。……