重度有机磷农药中毒78例临床分析

目的：探讨重度有机磷农药中毒的救治方法。方法：回顾性分析重度有机磷农药中毒78例的临床资料。结果：78例中痊愈71例,死亡7例。结论：早期、及时、足量阿托品,尽早阿托品化,仔细观察,呼吸衰竭者及时使用呼吸机可提高存活率。     

Oral Treatment of Organophosphate Poisoning in Mice

OBJECTIVE: Organophosphates are used as pesticides, herbicides, and chemical warfare agents. Treatment of organophosphate poisoning is with intravenous atropine and pralidoxime in addition to supportive care. This study determined the efficacy of oral agents in preventing death from organophosphate poisoning. METHODS: The organophosphate paraoxon (8 mg/kg) was used in a murine model with lethality at four and 24 hours as an end point. For oral treatment, 15 male Balbc mice were given either atropine sulfate (4 mg/kg), or a combination of atropine sulfate (4 mg/kg) with pralidoxime (100 mg/kg), by oral gavage. A control group of 22 mice received water by oral gavage. Chi-square analysis was used to compare results in the different groups. RESULTS: Of the control group, six of 22 survived to four hours after paraoxon exposure. Of the exposed animals treated with oral atropine, eight of 15 survived to four hours. Of the exposed animals treated with a combination of atropine and pralidoxime, 13 of 15 survived to four hours. All animals surviving to four hours survived to 24 hours. The increased survival of animals in the atropine group relative to the control group was not significant (p = 0.09). Survival was significant in the group treated with atropine and pralidoxime relative to atropine alone (p = 0.02) and to the control group (p = 0.0002). All treated mice surviving at four hours were alive at 24 hours. CONCLUSIONS: Both oral atropine and a combination of oral atropine and pralidoxime improved survival, and combination therapy achieved statistical significance. Generalization of this result to other organophosphate pesticides, other doses of paraoxon, and other species cannot be made without further investigations.     

Acute Abdomen Associated with Organophosphate Poisoning

Background

Pesticides are extensively used in developed and developing countries.

Objectives

The present study was designed to evaluate the clinical course of patients with carbamate or organophosphate poisoning presenting to a University-based emergency department (ED).

Methods

All consecutive patients admitted to our ED due to intoxication with carbamate or organophosphate compounds over a 2-year period were enrolled prospectively.

Results

A total of 49 consecutive patients (26 females) were diagnosed with carbamate or organophosphate poisoning in the 24-month study period. The mean age of the patients was 32 ± 13.1 years (range 16-70 years). Signs and symptoms most frequently noted in patients with organophosphate or carbamate poisoning were perspiration, vomiting, and bronchorrhea. Abdominal pain was reported by 65.3% of the patients. Abdominal ultrasonography was performed in 22 patients who complained of abdominal pain as a leading symptom. Among these, 63.6% were found to have abdominal free fluid. Pancreatitis and peritonitis developed in one case. Atropine treatment was administered for approximately 24-36 h, with a mean total dose of 13.75 ± 6.75 mg. Pralidoxime was administered to 70.9% of patients with organophosphate poisoning, but was not used in patients intoxicated with carbamates. Endotracheal intubation and mechanical ventilatory support were required in 14.2% of the patients. Mean duration of mechanical ventilation was 3.7 ± 2.2 days. The overall mortality rate was 10.2%.

Conclusion

Patients with a diagnosis of organophosphate poisoning should be screened for acute abdomen. The findings in our study suggest that these patients should undergo routine abdominal ultrasonography, especially in cases with abdominal pain along with other abdominal complaints.     

中毒严重程度评分在急性有机磷农药中毒中的临床意义

目的：探讨中毒严重程度评分（PSS）在急性有机磷农药中毒（AOPP）患者病情严重程度评估中的意义,以指导临床决策。方法：我院急救医疗中心2004年1月至2012年7月收治急性有机磷农药中毒患者73例．根据患者入院时的PSS评分分为1、2、3三组,比较三组的临床资料。结果：PSS评分越高,并发症发生率越高,住院天数越长;PSS评分与APACHEⅡ评分有良好的相关性。结论：PSS评分能反映急性有机磷农药中毒患者的病情严重程度,指导临床正确决策和预后判断。     

盐酸戊乙奎醚治疗急性有机磷中毒临床观察

目的：比较盐酸戊乙奎醚（长托宁）与阿托品治疗急性有机磷中毒（AOPP）的疗效。方法：将67例AOPP患者随机分为两组,以阿托品＋氯解磷定为对照组（32例）,长托宁＋氯解磷定为治疗组（35例）,比较两组的治疗效果。结果：治疗组中毒症状消失时间、CHE恢复程度、用药总量、治愈时间、反跳率均优于对照组（P〈0.05）。结论：长托宁是治疗AOPP较为理想的药物。     

未成年人有机磷中毒原因分析及健康教育

分析63例未成年有机磷中毒患者的中毒原因和途径。本组未成年有机磷中毒患者以消化道中毒多见,共40例（占63％）,其次是皮肤吸收中毒13例（占21％）,呼吸道吸收中毒7例（占11％）,其他3例。中毒原因：与儿童有关的包括误服、服毒自杀、在喷药环境中玩耍;与家长有关的包括用后未洗手、未更衣便接触儿童,误用农药作皮肤药或灭蚊剂等。认为有机磷农药管理有待加强,对监护人及年龄偏大患者进行相应的健康教育具有重大意义。健康教育包括：对家长和对未成年患者的预防知识宣教,如家长应正确保管、使用有机磷农药,儿童应认识其毒害性;中毒入院后用药、饮食等方面的知识指导,出院后加强休息和防止再次中毒等知识的指导。     

Serum Acetylcholinesterase and Prognosis of Acute Organophosphate Poisoning

Objective: The aim of this study is to investigate the prognostic value of serum acetylcholinesterase levels and their relationship with neurological syndromes (Type 1 syndrome, intermediate syndrome, and delayed polyneuropathy) in acute organophosphate poisoning. Materials and methods: Thirty-two consecutive patients with acute organophosphate poisoning admitted to the Ondokuz Mayis University Emergency Department from June 1999 to January 2001 were evaluated. Patients were assessed according to admission time, symptoms, and results of clinical exams and their serum acetylcholinesterase levels were determined on days 1, 2, 3, 7, and the last day. Results: There was no significant difference between the first-day serum acetylcholinesterase of the patients with severe poisoning (n=22, 68.75%) and of the patients with mild poisoning (n=10, 31.25%; NS). There was no discernible difference between the serum acetylcholinesterase obtained on days 1 and 3 after poisoning from the patients with intermediate syndrome (n=5, 15.6%; means: 0.90±0.65 vs. 0.88±0.53, 19.35 vs. 18.92%; NS, sensitivity=80%; specificity=87.5%). There was a significant difference between the serum acetylcholinesterase obtained on days 1 and 3 from the patients with nonintermediate syndrome (n=24, 75%; means: 1.05±0.24 vs. 1.68±0.29, 22.58 vs. 36.12%; p<0.001). There was no discernible significant difference in serum acetylcholinesterase between the patients with organophosphorus-induced delayed polyneuropathy (n=7, 21.8%) and nonorganophosphorus-induced delayed polyneuropathy. In the patients who died (n=5, 15.6%), serum acetylcholinesterase showed no discernible increase day 1–the last day (means: 0.50±0.25 vs. 0.46±0.26, 10.75 vs. 9.89%; NS). There was a significant difference between the serum acetylcholinesterase levels obtained on days 1 and the last day from the patients who survived (n=27, 84.3%; means: 1.14±0.25 vs. 2.32±0.26, 24.51 vs. 49.89%; p<0.001). Conclusion: In the acute phase of organophosphate poisoning, low serum acetylcholinesterase (>50% of minimum normal value) supports the diagnosis of organophosphate poisoning but it does not show a significant relationship to the severity of poisoning (NS). The serum acetylcholinesterase activity may be a useful parameter in following the acute prognosis of organophosphate poisoning.     

有机磷中毒致中间综合征的急救及护理

有机磷中毒除可引起急性胆碱能危象和迟发性多发性神经病变外,还可使某些患者于急性中毒后第1～4d发生中间期无力综合征,严重者可因呼吸肌麻痹而致死.本文通过对16例急性有机磷中毒致中间综合征患者的抢救治疗及护理,表明只要及时发现和处理中间综合征,合理的呼吸支持,严格的控制感染及预防并发症,有机磷中毒致中间综合征预后良好.     

急性中毒患者血清肿瘤坏死因子α检测的临床意义

目的 探讨血清肿瘤坏死因子α(TNFα)在急性中毒中的临床意义。方法 采用ELISA 法检测80例急性中毒患者(镇静催眠药、乙醇、一氧化碳、农业杀虫剂各20例)及20例正常人血清 TNFα。结果 急性镇静催眠药中毒组(SH 组)与急性一氧化碳中毒(CO 组)血清 TNFα均高于正常对照组(P<0.05,P<0.001),急性乙醇中毒组(AL 组)和急性农业杀虫剂中毒组(FI组)与对照组间差异无显著性(P>0.05);CO 组血清 TNFα明显高于 AL 组与 FI 组(P<0.001),余各组间差异无显著性(P>0.05);SH 组与 AL 组治疗后血清 TNFα均低于治疗前血清 TNFα(P<0.05),CO 组治疗后血清 TNFα明显低于治疗前(P<0.001),FI 组治疗后血清 TNFα与治疗前差异无显著性(P>0.05)。结论 血清 TNFα在急性镇静催眠药中毒及急性一氧化碳中毒中的增高是由于组织器官严重缺氧而刺激其升高,故抗氧化剂及氧自由基清除剂治疗急性镇静催眠药中毒、一氧化碳中毒等中毒机理为组织器官缺氧的急性中毒是有效的。     

Survival Pattern in Patients with Acute Organophosphate Poisoning Receiving Intensive Care

Background. Approximately 35% of patients acutely poisoned with organophosphates (OP) in developing countries like Sri Lanka require intensive care and mechanical ventilation. However, death rates remain high. Objective. To study the outcomes and predictors of mortality in patients with acute OP poisoning requiring intensive therapy at a regional center in Sri Lanka over a period of 40 months. Methods. Retrospective analysis of all intensive care records of patients with acute OP poisoning admitted to the Intensive Care Unit (ICU) between March 1998 and July 2001. Results. During the study period, 126 subjects were admitted to the ICU with acute OP poisoning. Records of 10 patients were lost and those of 37 were incomplete and hence were excluded. All the remaining 71 patients (59 male) had required endotracheal intubation and mechanical ventilation for a period of four (median) days (range 1–27) in addition to gastric lavage and standard therapy with atropine and oximes and adequate hydration. Of these 71 patients, 36 (28 male) had died. Life table analysis demonstrated a steep decline in the cumulative survival to 67% during the first three days. Systolic blood pressure of < 100 mmHg and FiO₂ of > 40% to maintain a SpO₂ of > 92% within the first 24 h were recognized as poor prognostic indicators among mechanically ventilated patients. Conclusion. Mortality following OP poisoning remains high despite adequate respiratory support, intensive care, and specific therapy with atropine and oximes. One‐third of the subjects needing mechanical ventilation and reaching intensive care units die within the first 72 h of poisoning. Systolic blood pressure of less than 100 mmHg and the necessity of a FiO₂ > 40% to maintain adequate oxygenation are predictors of poor outcome in patients mechanically ventilated in the ICU.     

氟乙酰胺中毒患者心肌酶活力变化及临床意义

目的:观察氟乙酰胺中毒患者血液心肌酶活力的变化,其中包括乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(α-HBDH)、谷草转氨酶(AST)、肌酸激酶(CK)和肌酸激酶同功酶(CK-MB).方法:在患者入院第1天和第7天分别采静脉血进行以上酶活力的测定,测定方法为动力学法,健康对照组选择门诊健康查体者,全部排除心、肝、肾、骨骼肌等器官可能引起心肌酶活力升高的相关疾病,检测方法同疾病组.结果:氟乙酰胺中毒患者检测心肌酶各项酶活力均明显升高,与健康对照比较,除入院第1天轻度中毒组无统计学差异外,其余各项均差异显著(P＜0.05和P＜0.01),而且与中毒程度有关.中毒越重,酶活力越高,随病程的延长,心肌酶活力呈逐渐上升趋势,各中毒组中毒第7天都远较第1天为高.两个时间比较,均差异显著(P＜0.05和P＜0.01),轻度中毒组与中、重度中毒组相同时间比较,各项酶活力升高差异非常显著(均P＜0.01).结论:氟乙酰胺中毒患者心肌酶活力明显升高,且与中毒程度有关,及时动态检测心肌酶活力变化,对了解中毒程度,观察心肌损伤状况,指导临床治疗有一定意义.     

The Effects of Fresh Frozen Plasma on Cholinesterase Levels and Outcomes in Patients with Organophosphate Poisoning

Objective: The aim of this study is to determine the effects of fresh frozen plasma, as a source of cholinesterase, on butyrylcholinesterase (BuChE; plasma or pseudo cholinesterase) levels and outcomes in patients with organophosphate poisoning. Materials and Methods: This prospective study was performed at the Department of Intensive Care of Erciyes University Medical School. Over 2 yrs, patients admitted to the ICU for OP poisoning were entered into the study. OP poisoning was diagnosed on the basis of history and BuChE levels. All patients received atropine. Fresh frozen plasma was given to 12 patients. The study was approved by the Ethical Committee, and verbal informed consent was obtained. Results: Thirty‐three patients were included in the study. BuChE levels measured at admission and the pralidoxime and atropine doses administered were not different between groups (p > 0.05). Although intermediate syndrome developed in 28.6% of patients receiving pralidoxime, there were no intermediate syndrome cases in patients receiving plasma prior to developing intermediate syndrome. The mortality rates were 14.3% in the pralidoxime group and 0% in the plasma + atropine + pralidoxime group. Two patients received plasma after developing the intermediate syndrome, and one patient who received only atropine died. BuChE levels of fresh frozen plasma were 4069.5 ± 565.1 IU/L. Every two bags of plasma provided an increase in BuChE levels of approximately 461.7 ± 142.1 IU/L. Conclusion: Fresh frozen plasma therapy increases BuChE levels in patients with organophosphate poisonings. The administration of plasma may also prevent the development of intermediate syndrome and related mortality. Plasma (fresh frozen or freshly prepared) therapy may be used as an alternative or adjunctive treatment method in patients with organophosphate pesticide poisoning, especially in cases not given pralidoxime. Further randomized controlled and animal studies are required to infer a definitive result.     

Glasgow Coma Scale Score and QTc Interval in the Prognosis of Organophosphate Poisoning

OBJECTIVES: The aim of this study was to assess the applicability of the Glasgow Coma Scale (GCS) score and the Q-T interval corrected for heart rate (QTc interval) in predicting outcome and complications in patients with organophosphate (OP) poisoning. METHODS: This prospective, observational study included 65 patients older than 18 years. In the out-of-hospital setting, the end-tidal carbon dioxide (ETCO2), oxygen saturation (SaO2), QTc interval, and GCS score were monitored in each patient. A statistical comparison was then made between the group with respiratory failure and the group without this complication. RESULTS: The group with complications had significantly different values of measured parameters--a longer QTc interval and a lower GCS score, a higher number of intubations, and worse outcomes (p < 0.05). The two measures, GCS score and QTc interval, have been shown to be equally good in predicting respiratory failure and hospital mortality in patients with OP poisoning. CONCLUSIONS: In the initial out-of-hospital care of patients with OP poisoning, it is essential to monitor QTc interval and GCS score. These measures help with prognosis, and may suggest when to initiate precautions to prevent complications (i.e., respiratory failure). The simplicity and promptness of these methods allow providers to perform early and effective triage.     

生理盐水反复洗胃在抢救有机磷中毒患者中的应用

目的　探讨不同洗胃方法救治有机磷中毒的疗效。方法　回顾性分析和比较单次清水洗胃与反复生理盐水洗胃对有机磷中毒患者救治效果的影响。结果　反复生理盐水洗胃组患者死亡率 4 .8% ,明显低于清水单次洗胃组患者死亡率 1 3.0 % ,P <0 .0 5。结论　改进洗胃方法 ,使用 37～ 4 1℃生理盐水反复洗胃优于单次清水洗胃法     

血液透析联合血液灌流治疗重度有机磷中毒40例疗效观察

目的：观察血液透析联合血液灌流治疗重度有机磷重度患者的疗效,评价其临床应用价值。方法以收治的80例重度有机磷中毒患者为研究对象,采用随机数字法分为2组,对照组40例患者在临床常规处理基础上采用血液透析治疗,治疗组40例在常规处理基础上采用血液透析联合血液灌流治疗,观察两组患者阿托品用量、阿托品化出现时间、胆碱酯酶（ChE）恢复时间、清醒时间、住院时间等,同时观察治疗效果。结果治疗组患者阿托品用量、阿托品化出现时间、胆碱酯酶（ChE）恢复时间、清醒时间、住院时间均明显低于对照组（P＜0.05）;治疗组治愈率明显高于对照组（P＜0.05）。结论临床上采用血液透析联合血液灌流治疗重度有机磷中毒能明显提高抢救成功率,缩短抢救的时间,提高治愈率,降低死亡率,进而改善患者的生存质量,值得在临床上广泛的推广和应用。     

血清淀粉酶在急性有机磷农药中毒患者病情评估中的意义

目的：探讨急性有机磷农药中毒患者血清淀粉酶监测对中毒病人病情评估及临床治疗的意义。方法：116例急性有机磷农药中毒患者根据血清淀粉酶水平将患者分为三组：正常淀粉酶组（A,n=78）、中度增高淀粉酶组（B,n=25）和高淀粉酶组（C,n=13）,对比分析三组病人的白细胞升高率,低血压、呼吸衰竭、消化道出血和肺部感染发生率,治愈率及病死率。结果：116例急性有机磷农药中毒患者38例血清淀粉酶升高,高淀粉酶血症的发生率为32.8%。A、B、C三组并发症（白细胞升高、低血压、消化道出血、肺部感染、呼吸衰竭）发生率呈递增态势;A组死亡率为1.3%,B组死亡率为12.0%,C组死亡率为53.8%。结论：血清淀粉酶水平与急性有机磷农药中毒患者病情危重程度、并发症发生率及预后呈平行关系。在急性有机磷农药中毒救治时应重视对血清淀粉酶的监测,以及时发现和治疗危重病例,提高治愈率,改善预后。     

Early Death Due to Severe Organophosphate Poisoning Is a Centrally Mediated Process

OBJECTIVE: To distinguish whether early death from severe organophosphate (OP) poisoning with dichlorvos is mediated through peripheral or central nervous system (CNS) actions. METHODS: Wistar rats (n = 72) were randomized to pretreatment with either: normal saline (controls), peripheral anticholinergics (glycopyrrolate [low, medium, or high dose] or nebulized ipratropium bromide), or CNS + peripherally acting anticholinergics (diphenhydramine, nebulized atropine, or injected atropine). All treatments were given prior to a subcutaneous injection of 25 mg/kg dichlorvos (n = 8 per group). Survival was assessed at 10 minutes (early death) and 24 hours (delayed death). Kaplan-Meier (95% confidence intervals [95% CIs]) and chi-squared analysis was then performed to determine differences between treatments. RESULTS: Regardless of treatment, all animals exhibited profound nicotinic effects (fasciculations) without obvious seizures within 2 minutes of poisoning. In rats pretreated with peripherally acting agents, the fasciculations were rapidly followed by reduced motor activity, sedation, and death. Mortality at 10 minutes for saline controls, glycopyrrolate, and ipratropium was 88%, 96%, and 100%, respectively. The single control animal surviving beyond 10 minutes went on to develop peripheral cholinergic manifestations, including hypersalivation, urination, and defecation. Only one of 24 animals treated with injected atropine, nebulized atropine, or diphenhydramine died during the early phase of poisoning; all others survived to 24 hours (p < 0.01). CONCLUSIONS: Death in acute, severe OP poisoning is prevented by pretreatment with anticholinergic agents that cross the blood-brain barrier, but not by agents with only peripheral actions. Early death due to OP poisoning appears to be a centrally mediated process.     

重度有机磷中毒反跳现象一例教训分析

1 病例资料 女,25岁.因自服乐果(约100 mL)半小时被家人送入院.查体:体温36℃,脉搏80/min,呼吸20/min,血压110/80 mmHg.浅昏迷,全身发绀,双侧瞳孔缩小如针尖大小.口唇发绀,口吐白沫.双肺听诊满布湿啰音,心率80/min,律齐.腹平软,肝、脾未触及,肠鸣音减弱.