1例老年抑郁患者有机磷和抗凝血鼠药中毒的MDT救治策略

doi:10.11958/20252004

天津医药 ›› 2025, Vol. 53 ›› Issue (9): 1000-1004.doi: 10.11958/20252004

1例老年抑郁患者有机磷和抗凝血鼠药中毒的MDT救治策略

付莎莎¹(), 贾月¹, 邵红霞², 郭禹¹, 马龙艳³, 韩同¹, 孙浩¹, 于洪志¹^,^△()

1 天津大学海河医院综合ICU（邮编300350）
2 天津大学海河医院感染科（邮编300350）
3 天津大学海河医院急诊科（邮编300350）

收稿日期:2025-05-16 修回日期:2025-06-12 出版日期:2025-09-15 发布日期:2025-09-16
通讯作者: ^△E-mail：13512205663@163.com
作者简介:付莎莎（1985），女，副主任医师，主要从事急危重症患者救治方面研究。E-mail：yeqi850504@163.com
基金资助:
天津市第二批卫生健康行业高层次人才选拔培养工程入选人才培养基金资助项目(TJSJMYXYC-D2-012)

MDT treatment strategy for organophosphorus and anticoagulant rodenticide poisoning in an elderly patient with depression

FU Shasha¹(), JIA Yue¹, SHAO Hongxia², GUO Yu¹, MA Longyan³, HAN Tong¹, SUN Hao¹, YU Hongzhi¹^,^△()

1 Department of Critical Care Medicine, Tianjin University Haihe Hospital, Tianjin 300350, China
2 Department of Infectious Diseases, Tianjin University Haihe Hospital, Tianjin 300350, China
3 Department of Emergency, Tianjin University Haihe Hospital, Tianjin 300350, China

Received:2025-05-16 Revised:2025-06-12 Published:2025-09-15 Online:2025-09-16
Contact: ^△E-mail: 13512205663@163.com

付莎莎, 贾月, 邵红霞, 郭禹, 马龙艳, 韩同, 孙浩, 于洪志. 1例老年抑郁患者有机磷和抗凝血鼠药中毒的MDT救治策略[J]. 天津医药, 2025, 53(9): 1000-1004.

FU Shasha, JIA Yue, SHAO Hongxia, GUO Yu, MA Longyan, HAN Tong, SUN Hao, YU Hongzhi. MDT treatment strategy for organophosphorus and anticoagulant rodenticide poisoning in an elderly patient with depression[J]. Tianjin Medical Journal, 2025, 53(9): 1000-1004.

摘要/Abstract

摘要：

有机磷农药（OP）是全球使用最广泛、用药量最大的杀虫剂之一，急性有机磷农药中毒（AOPP）为临床常见疾病，我国每年发生的中毒病例中AOPP占20%~50%，病死率达3%~40%。溴鼠灵（BDF）属于长效抗凝血杀鼠剂，通过抑制维生素K环氧还原酶，干扰凝血因子Ⅱ、Ⅶ、Ⅸ、Ⅹ的合成，导致凝血功能障碍。介绍1例敌敌畏与溴鼠灵复合中毒患者的多学科诊疗（MDT）过程，探讨了有机磷中毒及抗凝血杀鼠剂复合中毒患者的血液净化、凝血异常处理、继发感染、阿托品化、意识改变等关键问题，为临床医生的及早诊治提供参考。

关键词: 有机磷中毒, 血液凝固障碍, 意识障碍, 同时感染, 杀鼠剂中毒, 阿托品化, 多学科诊疗

Abstract:

Organophosphorus pesticide (OP) is one of the most widely used pesticides in the world with the largest dosage. Acute organophosphorus pesticide poisoning (AOPP) is a common clinical disease, and AOPP accounts for 20%-50% of poisoning cases in China every year, with case fatality rate of 3%-40%. Bromophos (BDF) is a long-acting anticoagulant rodenticide, which inhibits vitamin K epoxide reductase and interferes with the synthesis of coagulation factors Ⅱ, Ⅶ, Ⅸ and Ⅹ, leading to coagulation dysfunction. This article discusses the multidisciplinary diagnosis and treatment (MDT) process of a patient with combined poisoning of dichlorvos and bromadiolone. The article explores blood purification, management of coagulation abnormalities, secondary infection, atropinization and altered consciousnes in patients with organophosphorus poisoning and anticoagulant rodenticide compound poisoning, with the aim of providing clinicians with references for early diagnosis and treatment.

Key words: organophosphate poisoning, blood coagulation disorders, consciousness disorders, coinfection, rodenticide poisoning, atropinization, multidisciplinary diagnosis and treatment

中图分类号:

R595.5

图/表 3

图1 患者入院当日胸部X线片

Fig.1 Chest X-ray of the patient on the day of hospitalization

图2 患者治疗初期（入院4 d）胸部CT表现 A：双肺上叶渗出影；B：左肺下叶渗出影；C：左肺下叶渗出实变；D：双肺底病变。

Fig.2 Chest CT findings at the initial stage（the fourth day after admission）of treatment

图3 患者出院2周后胸部CT表现 A：双肺上叶渗出影吸收；B：左肺下叶渗出影吸收；C：双肺下叶渗出影吸收；D：双肺底病变吸收。

Fig.3 Chest CT findings of the patient two weeks after diacharge

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1例老年抑郁患者有机磷和抗凝血鼠药中毒的MDT救治策略

MDT treatment strategy for organophosphorus and anticoagulant rodenticide poisoning in an elderly patient with depression

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