Comparison of two therapies in treating acute organophosphorus pesticide poisoning / 中国中西医结合急救杂志

ABSTRACT

Objective To investigate the clinical effect of rhubarb combined with smecta in the treatment of acute organophosphorus pesticide poisoning (AOPP).Methods Seventy-six patients with severe AOPP admitted in the Emergency Centre of Heze Municiple Hospital in Shandong Province from June 2011 to June 2014 were enrolled in this study. They were divided into observation group and control group by the random number table method, 38 cases in each group. The comprehensive routine treatment of gastric lavage to thoroughly clear the gastric content, appropriate application of penehyclidine and atropine for detoxication, pralidoxime chloride, etc. were given to the two groups. On the basis of the above conventional treatment, the observation group was treated with rhubarb 30 g for catharsis and smecta 30 g for adsorption once in every 4 hours, two drugs applied alternately for 48 hours, while the control group was treated with 33% magnesium sulfate 60 mL for catharsis and bleaching clay 200 g for adsorption once in every 4 hours, two drugs applied alternately for 48 hours. The treatment effect, dosage, incidence of complication and case fatality rate in both groups were observed.Results The first defecation time (hours 5.8±3.7 vs. 9.4±4.6), gastrointestinal function recovery time (hours 21.7±6.1 vs. 25.2±8.3), atropinization time (minutes 51.8±23.9 vs. 68.5±20.1), conscious recovery time (days 2.3±1.2 vs. 3.6±1.9), the time of cholinesterase (ChE) activity returning to more than 50% (days 4.7±2.3 vs. 6.1±2.9) and the length of stay in hospital (days 9.2±4.9 vs. 12.3±6.9) were obviously shorter in the observation group than those of the control group (P < 0.05 orP < 0.01); the used dosage of atropine (mg 234.3±37.1 vs. 265.7±31.4) and penehyclidine (mg 19.2±14.3 vs. 36.7±25.4) and the incidence of adverse reactions of poisoning rebound [7.9% (3/38) vs. 31.6% (12/38)], intermediate syndrome [2.6% (1/38) vs. 18.4% (7/38)], delayed neuropathy [0 (0/38) vs. 15.8% (6/38)] in the observation group were significantly lower than those of the control group (P < 0.05 orP < 0.01). No death occurred in both groups.Conclusion At present, the combination of smecta and rhubarb is a relatively good method of catharsis and adsorption to completely clear the gastrointestinal toxic residues inside the patients with AOPP, and it can reduce the amount of drugs used, the incidence of complications and the duration of hospital stay.