Clinical study of effect of penehyclidine hydrochloride and atropine sequential therapy in the treatment of severe acute organophosphorus pesticide poisoning

Abstract

To investigate the clinical efficacy of penehyclidine hydrochloride sequential to atropine in severe acute organophosphorus pesticide poisoning (AOPP). A retrospective analysis of the clinical data of 180 patients with severe AOPP admitted to the Emergency Center of Wuwei City People's Hospital from January 2007 to August 2011 was conducted. The patients were divided into penehyclidine hydrochloride sequential to atropine group, atropine group and penehyclidine hydrochloride group according to difference of anti-choline drugs using, with 60 cases in each group. The complication rate, time of recovery of cholinesterase (ChE) activity to 70％, hospital stay time and cost, the cure rate, mortality rate in three groups were analyzed. In penehyclidine hydrochloride sequential to atropine group, except for 1 case of cancer of gastric cardia with poisoning after operation showing intermediate syndrome of poisoning, the remaining patients did not have any complication, and the incidence of complications was 1.67％.No death occurred in all the patients, and the cure rate was 100.00％.Time of recovery from ChE activity to 70％ was (4.0 ± 1.1 ) days; hospital stay was (7.0 + 2.2) days; hospital expenses were (6268 ± 238 ) yuan. In atropine group, 3 patients were found to have atropine resistance, 3 patients showed intermediate syndrome, rebound was observed in 2 cases, atropine poisoning in 2 patients, and the incidence of complications was 16.67％.Three patients died of respiratory or circulatory failure, and the mortality rate was 5.00％.Fifty-seven patients were cured, the cure rate was 95.00％.The time of ChE activity recovery to 70％ was (8.0 ± 0.9) days. Hospital stay was (12.0 ± 2.1) days. Hospital expenses were (7160 ± 110) yuan. In penehyclidine hydrochloride group, 1 patient was found to have respiratory failure, 1 case suffered from pulmonary edema, and the complication rate was 3.33％.Two patients died, the mortality rate wan 3.33％.Fifty-eight patients were cured, the cure rate was 96.67％.The time of ChE activity recovery to 70％ was (6.0 ± 0.7) days, hospital stay was (9.0 ± 1.5) days, and hospital expenses were (7921 ± 230) yuan. Compared with atropine group, penehyclidine hydrochloride sequential to atropine group had a low death rate, high cure rate, less complications, ChE activity recover fast, short hospital days, and the hospitalization expenses were lower than that of the single use of atropine or single use of penehyclidine hydrochloride group, and the differences were statistically significant (all P＜0.01). In treatment of severe AOPP by penehyclidine hydrochloride sequential to atropine, curative effect was more significant, with fewer adverse reactions, short hospital stay, and lower cost.