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目的 了解急性混配农药中毒的临床表现特点 ,以提高混配农药中毒的诊治水平。方法 1996～ 2 0 0 0年在农药中毒高发地区的 6个县市级医院 ,按统一观察表格和检查的要求 ,对急性农药中毒患者进行临床观察和诊治研究。结果 共收治急性混配农药中毒 (混配组 ) 15 6例和急性单剂农药中毒 (单剂组 ) 115例。混配组中 ,含有机磷杀虫剂 (OP)的混配中毒 15 0例 ,含氨基甲酸酯杀虫剂 (CB)不含OP的混配中毒 6例。单剂组中 ,OP中毒 10 9例 ,CB中毒 6例。混配和单剂组患者均以急性胆碱能兴奋或危象为主要临床表现 ,以头晕、乏力、多汗、流涎、恶心、呕吐、瞳孔缩小、肌束震颤多见 ,重者出现昏迷、肺部湿音、大小便失禁 ;两组全血ChE活力均下降 ,范围分别为7%～ 73%和 5 %～ 70 %。在急性中毒 1～ 4天胆碱能危象基本控制后 ,含OP的混配组中 6例以及OP单剂组 9例出现屈颈肌与四肢近端肌肉及脑神经支配的肌肉无力 ,其中混配组 4例及单剂组 6例尚出现呼吸肌无力。参照相关诊断标准及分级建议 ,混配组分别诊断急性轻度、中度和重度混配农药中毒 61例、 67例和 2 8例 ,其中合并轻型中间期肌无力综合征 (IMS) 2例、重型IMS 4例 ;单剂组分别诊断急性轻度、中度和重度单剂农药中毒 2 9例、 35例和 5 1例 ,其中合并轻型I
Objective To understand the clinical characteristics of acute mixed pesticide poisoning in order to improve the diagnosis and treatment of mixed pesticide poisoning. Methods From 1996 to 2000, six county-level hospitals in areas with high incidence of pesticide poisoning were enrolled in this study. The clinical observation, diagnosis and treatment of patients with acute pesticide poisoning were conducted according to the unified observation form and examination requirements. Results A total of 15 6 cases of acute mixed pesticide poisoning (mixed group) and 115 cases of acute single chemical pesticide poisoning (single dose group) were treated. In the mixed group, 15 cases were mixed with organophosphate insecticides (OP) and 6 cases were mixed with carbamate insecticides (CB) without OP. In the single dose group, 109 cases of OP poisoning and 6 cases of CB poisoning. Mixed and single-dose group of patients with acute cholinergic excitement or crisis as the main clinical manifestations, dizziness, fatigue, hyperhidrosis, salivation, nausea, vomiting, miosis, muscle tremors more common, severe coma, Lung wet tone, incontinence, two groups of whole blood ChE activity decreased, ranging from 7% to 73% and 5% to 70%. In the acute poisoning 1 to 4 days cholinergic crisis basic control, with OP mixed group of 6 patients and OP single agent group of 9 patients with flexion and proximal limb muscle and innervation of the muscle weakness, of which Respiratory muscle weakness occurred in 4 patients in combination group and in 6 patients in single dose group. According to the relevant diagnostic criteria and grading recommendations, 61 cases, 67 cases and 28 cases of acute mild, moderate and severe mixed pesticide poisoning were diagnosed in the mixed group, including 2 cases of mild myasthenia gravis syndrome (IMS) Heavy-duty IMS in 4 cases; single-dose group were diagnosed with acute mild, moderate and severe single dose of pesticide poisoning in 29 cases, 35 cases and 51 cases, of which light I