有机磷酯类杀虫剂中毒致胃隐血和脑梗死1例

A Case of Occult Gastric Bleeding and Cerebral Infarction Caused by Organophosphorus Insecticide Poisoning

摘要: 本文就1例自服用有机磷酯类杀虫剂中毒致胃隐血并发脑梗死的案例进行回顾分析。患者口服杀螂饵剂20 g (乙酰甲胺磷5%、毒死蜱1%) 3小时后腹痛、频繁恶心呕吐后就诊。结合明确毒物接触史及临床表现，诊断为急性杀虫剂中毒。患者洗胃结束4小时后突发脑梗死，治疗3天后症状缓解自行离院，2周后复查胃镜显示黏膜愈合。笔者认为：有机磷酯类杀虫剂中成分可能对胃黏膜具有直接腐蚀作用，且中枢神经系统损害也与有机磷酯类杀虫剂中毒有关。提示首诊医师接诊上消化道出血时需警惕杀虫剂中毒可能，及时洗胃与针对性胃黏膜保护治疗是改善预后的关键，同时呼吁加强毒饵的安全管理及公众急救知识宣教。

Abstract: This article conducts a retrospective analysis of a case involving gastric occult bleeding complicated by cerebral infarction following intentional ingestion of an organophosphorus insecticide. A patient presented to the hospital 3 hours after orally consuming 20 g of cockroach bait (containing 5% acephate and 1% chlorpyrifos) with symptoms of abdominal pain, persistent nausea, and vomiting. Based on a clear history of toxic exposure and clinical manifestations, the patient was diagnosed with acute insecticide poisoning. Four hours after completing gastric lavage, the patient suddenly developed cerebral infarction. Symptoms improved after 3 days of treatment, and the patient self-discharged. Follow-up gastroscopy at 2 weeks demonstrated mucosal healing. I suggest that components of organophosphorus insecticides may exert a direct effect on the gastric mucosa, and central nervous system injury may also be associated with such poisoning. This case highlights that clinicians should consider insecticide poisoning as a potential etiology when evaluating patients with upper gastrointestinal bleeding. Prompt gastric lavage and targeted mucosal protective therapy are critical for improving prognosis. Additionally, this report emphasizes the urgent need to enhance safety regulations for toxic baits and strengthen public education on emergency medical interventions.