目的:比较观察阿托品和盐酸戊乙奎醚(商品名:长托宁)分别用于重度有机磷中毒(acute organophosphorus pesticide poisoning,AOPP)抢救的疗效.方法:选掸60例重度AOPP患者,随机分成长托宁+氯解磷定组(P组)及阿托品+氯解磷定组(A组),各30例,两组基础治疗相同,P组肌注长托宁4～6 mg,氯磷定2.0～3.0 g静脉注射;A组给予阿托品首剂10～20 mg静脉注射后间断维持,同时氯磷定2.0～3.0 g静脉注射,观察记录两组患者毒蕈碱样症状消失时间、烟碱样症状消失时间、中枢神经系统症状消失时间及胆碱酯酶活力恢复60%时间,统计各组治愈率、住院时间及严重并发症发生率,观察药物不良反应发生情况.结果:P组患者蕈碱样症状消失时间、烟碱样症状消失时间、中枢神经系统症状消失时间及胆碱酯酶活力恢复60%时间均低于A组(P＜0.05),P组胆碱酯酶活力恢复明显较A组快,P组治愈率高于A组(P＜0.05),P组住院时间较A组缩短,严重并发症发生率及药物不良反应发生率P组均低于A组(P＜0.05).结论:长托宁能有效缓解重度AOPP症状,促进胆碱酯酶活力恢复,不良反应少,是较阿托品更为理想的重度AOPP治疗药物.%Objective: To compare the therapeutic effect of Atropine and Penehyclidine Hydrochloride used for severe acute organophosphorus pesticide poisoning (AOPP). Methods: 30 cases of severe acute organophosphorus pesticide poisoning were selected and divided into Penehyclidine Hydrochloride + Pyraloxime Chloride group (group P) and Atropine + Pyraloxime Chloride group (group A) randomly. The same basic treatment was given, 4-6 mg Penehyclidine Hydrochloride im and 2.0-3.0 g Pyraloxime Chloride iv for group P, 10-20 mg initial dose of Atropine iv and 2.0-3.0 g Pyraloxime Chloride iv for group A. Then extinction time of M sample, extinction time of N sample, extinction time of CNS sample and time of recovery 60％ ChE activity were observed, cure rate, LOS. severe complications rate and drug adverse reaction incidence were calculated. Results: Extinction time of M sample, extinction time of N sample, extinction time of CNS sample and time of recovery 60％ ChE activity of group P were shorter than group A (P＜0.05), ChE activity recovered faster in group P,cure rate of goup P was higher (P＜0.05), LOS of goup P was shorter (P＜0.05), severe complications rate and drug adverse reaction incidence were also lower in group P (P＜0.05). Conclusion: Penehyclidine Hydrochloride can effectively relief symptom of severe AOPP, and promote recovery of ChE activity with less adverse effect, it is a kind of anticholinergic drug which is more ideal than Atropine for severe AOPP treatment.
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