Objective To investigate the effects of hyperbaric oxygen combined with ulinastatin on choline acetyltransferase (ChAT), malondialdehyde (MDA), and myocardial function in rats with acute organophosphorus pesticide poisoning. Methods 50 specific-pathogen-free (SPF) male SD rats were randomly divided into five groups of ten each: normal group (N), model group (M), hyperbaric oxygen group (H), and ulinastatin group (U), and hyperbaric oxygen combined ulinastatin (O) group. The model of acute organophosphorus pesticide poisoning was established in the M, H, U, and O groups via cumulative subcutaneous injections on the neck back, and the N group did not set up the model. After the success of the modeling, the H group was treated with hyperbaric oxygen therapy, and the U group was intraperitoneally injected with ulinastatin at a dose of 100 000 U/kg.The O group received a combination of hyperbaric oxygen and ulinastatin treatment, whereas the N and M groups were gavaged with an equivalent volume of saline. The rats' myocardial function was assessed through cardiac echocardiography, brain tissue pathology was examined using hematoxylin and eosin (HE) staining and Nissl staining, cardiomyocyte apoptosis was evaluated by TUNEL assay, and ChAT and acetylcholine (Ach) content in rat brain tissues were determined through histochemical methods. Serum levels of MDA and superoxide dismutase (SOD) were measured using the thiobarbituric acid reactive substances (TBARS) assay. Statistical analysis was performed by SPSS 22.0. Results Compared with Group N, the left ventricular end systolic dimension (LVSD) and left ventricular end diastolic dimension (LVDD) in Group M were both enlarged, with increased interventricular septum (IVS) thickness, aggravated left ventricular strain (LVS), increased number of apoptotic cardiomyocytes, and elevated Ach and MDA levels (P<0.05). Additionally, the left ventricular ejection fraction (LVEF) decreased, while ChAT and SOD levels also decreased (P<0.05). When compared to Group M, both Groups H and U exhibited reduced LVSD and LVDD, thinner IVS, decreased LVS, and fewer apoptotic cardiomyocytes. Furthermore, Ach and MDA levels were lower (P<0.05), while LVEF, ChAT, and SOD levels were higher (P<0.05). No statistically significant difference was observed between Groups U and H (P>0.05), while Group O showed more pronounced changes compared to Group U (P<0.05). Rats in Group N exhibited normal brain tissue pathological morphology, while those in Group M suffered severe damage to brain tissue structure. Compared to Group M, significant improvements in symptoms were observed in Groups H, U, and O. Conclusions Hyperbaric oxygen combined with ulinastatin has a significant effect on acute organophosphorus pesticide poisoning rats, which can significantly increase ChAT content, decrease MDA content, and effectively improve myocardial function. [ABSTRACT FROM AUTHOR]