盐酸戊乙奎醚与阿托品治疗急性有机磷农药中毒过程中的谵妄对比研究

Difference in delirium between treatment of acute organophosphorus pesticide poisoning by Penehyclidine and Atropine

摘要:

目的  比较阿托品、盐酸戊乙奎醚（长托宁）在治疗急性有机磷农药中毒（AOPP）时发生药源相关性谵妄的差异。方法  2011年5月-2015年4月该院收治121例急性有机磷农药中毒临床患者，随机分为阿托品组59例（给予常规阿托品治疗）和长托宁组62例（给予常规长托宁治疗）。采用重症监护谵妄筛查评分（ICDSC），评估谵妄的分值，分析比较两组患者谵妄的发生率、出现时间及持续时间，并记录患者毒蕈碱样（M）症状消失时间、胆碱酯酶（CHE）恢复时间及住院时间。结果  长托宁与阿托品两组总体比较，长托宁组患者的胆碱酯酶活性恢复时间短于阿托品组（P <0.05），总体存活率高于阿托品组（P <0.05），但两组住院时间比较差异无统计学意义。阿托品能使中、重度中毒患者更快地达到M胆碱受体阻断效应（P <0.05）。虽然阿托品组的谵妄出现较早，但是使用长托宁的中、重度患者的谵妄发生率、谵妄的持续时间均高于阿托品组（P <0.05）。结论  虽然长托宁在治疗有机磷农药中毒时疗效较好，但是应重视与其相关的谵妄副作用。采用ICDSC评分系统或许可以在阿托品或长托宁的用量上起到一定的指导作用，从而减少药物相关性谵妄的发生。

Abstract:

Objective To compare Penehyclidine-induced delirium with Atropine-induced delirium in the treatment of acute organophosphorus pesticide poisoning (AOPP). Methods Totally 121 clinical cases of AOPP, who were treated from May 2011 to April 2015, were randomly divided into Atropine group (n = 59, receiving regular Atropine treatment) and Penehyclidine group (n = 62, receiving regular Penehyclidine treatment). The Intensive Care Delirium Screening Scale (ICDSC) was used to assess the scores of delirium. The incidence, starting time and duration of delirium in the two groups were analyzed and compared. The disappearance time of muscarinic symptoms (M), the recovery time of cholinesterase (CHE) and the duration of hospital stay were recorded. Results The recovery time of CHE in the Penehyclidine group was significantly shorter than that in the Atropine group, and the overall cure rate in the Penehyclidine group was higher than that in the Atropine group (P < 0.05), but there was no significant difference in the average duration of hospital stay between the two groups. Atropine could block M choline receptor more quickly in the moderate and severe poisoning patients than Penehyclidine (P < 0.05). Although delirium appeared earlier in the Atropine group (P < 0.05), the incidence of delirium was significantly higher and the duration of delirium was longer in the Penehyclidine group than in the Atropine group (P < 0.05). Conclusions Although Penehyclidine has good therapeutic effect on AOPP, the related delirum should be valued. Maybe the ICDSC can be taken as a guidance for the dosage of Penephyclidine or Atropine to reduce the occurrence of drug-related delirium.