急性有机磷中毒所致非神经系统损害

本文对近10年来文献报道的急性有机磷中毒引起的非神经系统损害作一综述,着重介绍了有机磷中毒对心脏、肝脏、肾脏和内分泌系统的影响。     

肟类复能剂在治疗急性有机磷农药中毒中的作用

本文综述了肟类复能剂的种类、作用机制的研究进展以及目前临床的应用情况,以利于临床正确、有效地应用肟类复能剂治疗AOPP.     

急性有机磷中毒的解毒治疗进展

急性有机磷中毒（ＡＯＰＰ）是我国发病人数最多的急性农药中毒,每年达５～７万人,病死率达１０％以上［１,２］,目前仍以抗胆碱药与肟类药物联合应用为主要治疗措施,治愈率约为２０％～７０％［３,４］。现拟结合其解毒机制对其合理治疗问题,简介如下。一、抗胆碱药（ａｎｔｉｃｈｏｌｉｎｅｒｉｃｓ）该类药物主要有阿托品（ａｔｒｏｐｉｎｅ）、东莨菪碱（ｓｃｏｐｏｌａｍｉｎｅ）和山莨菪碱（ａｎｉｓｏｄａｍｉｎｅ）等［３,５８］,实际中多首选阿托品。近年,东莨菪碱和山莨菪碱的应用也得到重视［９,１０］。（一）目前…     

有机磷农药中毒患者的抢救治疗与护理体会

目的：探讨有机磷农药中毒的抢救措施及护理要点。方法：回顾性分析51例有机磷农药中毒患者的抢救及护理过程。结果：通过抢救和护理,绝大多数患者治愈,预后良好。结论：及时抢救措施和专业护理是有机磷农药中毒患者救治成功的关键。     

Chronic neurological sequelae of acute organophosphate pesticide poisoning

To evaluate the latent neurological effects of organophosphate pesticide poisoning, this epidemiologic study examined 100 matched-pairs of individuals with previous acute organophosphate pesticide poisoning and nonpoisoned controls. No significant difference between poisoned subjects and controls was found on audiometric tests, ophthalmic tests, electroencephalograms, or the clinical serum and blood chemistry evaluations. Of the more than 50 scores from the neurological examination, abnormalities were demonstrated among the cases only on measures of memory, abstraction, and mood, and on one test of motor reflexes. Differences between the two cohorts were much more apparent in the neuropsychological tests. The differences occurred on tests of widely varying abilities including intellectual functioning, academic skills, abstraction and flexibility of thinking, and simple motor skills. Twice as many cases as controls (24 vs. 12) had Halstead-Reitan Battery summary scores in the range characteristic of individuals with cerebral damage or dysfunction. Results from the Minnesota Multiphasic Personality Inventory and the Patient's and Relative's Assessment of Patient Functioning Inventories also revealed greater distress and complaints of disability for the poisoned subjects.     

Epidemiology of acute organophosphate poisoning in hospital emergency room patients

Acute organophosphate (OP) poisoning is a major health issue in developing countries. Organophosphate insecticides inhibit cholinesterase (ChE) enzymatic activity, thereby eliciting cholinergic signs and symptoms. Victims of OP poisoning require immediate hospital emergency room (ER) treatment to prevent a fatal outcome. We present an epidemiologic review of acute OP poisoning in hospital ER patients. Areas of interest include countries with acute OP poisoning, nature of exposure, gender and age of patients, clinical cholinergic features, ChE activity, and health outcome, including recovery rate, case fatality rate, and post-ER complications. The review comprises case reports, hospital surveys, and clinical studies on acute OP poisoning. More studies were conducted in developed than in developing countries. Suicidal and occupational OP poisoning in agricultural workers was prevalent in developing countries, whereas accidental OP poisoning was prevalent in developed countries. Healthcare workers in the ER were also affected by OP poisoning. Both males and females were affected. Children accounted for 35% of the OP-poisoned victims. Patients presented with a classic cholinergic syndrome and serum ChE depresssion, with a recovery rate above 90%. Neurologic impairment was the most frequent complication. Preventing environmental OP exposure and increasing the awareness of pesticide toxicity would reduce acute OP poisoning and protect human health.     

急性有机磷中毒实验治疗药物研究的进展

提高急性有机磷中毒抢救成功率、降低病死率是医药卫生工作者面临的艰巨任务。在合理应用传统的解毒剂抗胆碱药(阿托品等)和胆碱酯酶重活化剂(肟类)的同时，研究人员也在寻找治疗有机磷中毒的新药。现将近十几年实验研究发现的有苗头的药物作一综述，供研究和临床应用参考。     

Central nervous system effects and visual fatigue in VDT workers

Summary To assess central nervous system effects and visual fatigue induced by work with visual display terminals (VDT), symptom frequency was assessed and visual evoked potential (VEP), critical flicker fusion (CFF) and near-point distance were measured in 24 female keypunchers before and after 2.5 h of VDT work and in 6 non-VDT-exposed subjects at the same intervals. Each keypuncher had been engaged in data entry for 1–7 (mean, 4) years. After VDT work, the number of complaints of subjective fatigue as well as an objective measure of near-point distance were significantly increased as compared with those before work; also, the N75, P100 and N145 latencies of VEP were significantly prolonged. The change of P100 latency during VDT work was inversely correlated with the number of years worked in data entry. No significant change was seen in any of these tests in the non-VDT-exposed subjects. The changes in N75 latency and subjective fatigue related to drowsiness and dullness in the keypunchers were significantly larger than those in the non-VDT-exposed subjects. The CFF was significantly lower in keypunchers than in non-VDT-exposed subjects in both the first and the second tests. These data suggest that VDT work is associated with impairment of the visual nervous system function, that VEP latencies appear to be a sensitive indicator of visual fatigue, at least transiently, and that CFF appears to be a good parameter for estimations of chronic visual fatigue.     

集束化护理干预在急性重度有机磷中毒救治中的应用效果

目的分析集束化护理干预在急性重度有机磷中毒救治中的应用效果。方法在本院接受住院治疗的急性重度有机磷中毒患者作为研究对象,分别接受常规护理与集束化护理干预,比较2者肠道清洁时间、阿托品化时间、CHE恢复正常时间、住院时间、治疗费用等情况差异。结果观察组患者肠道清洁时间（9.63±2.05）h、阿托品化时间（46.23±12.41）min、CHE恢复正常时间（3.74±1.03）d、住院时间（6.03±2.12）d、治疗费用（3729.46±732.09）元均明显低于对照组（P〈0.05）。结论集束化护理干预可促进患者康复进度,缩短住院时间,减少住院治疗费用。     

急性有机磷农药中毒导致呼吸肌麻痹患者的护理体会

有机磷中毒后呼吸肌麻痹是较为常见的危重症之一,也是此类疾病致死的重要原因之一,做好呼吸肌麻痹病人的护理可最大程度减少其病死率。     

64例急性有机磷中毒救治过程中继发阿托品中毒的临床分析

目的探讨急性有机磷农药中毒救治过程中继发阿托品中毒的临床分析。方法选择2009年6月～2010年6月期间笔者所在医院收治的急性有机磷农药中毒救治过程中阿托品过量患者157例,并行常规洗胃和应用胆碱脂酶复能剂以及对症支持治疗,并尽早应用阿托品,同时对于继发阿托品中毒患者也应采取相应的救治措施。结果本研究中继发48例（41．40％）不同程度的阿托品中毒,与非阿托品中毒组相比,阿托品中毒组患者的心率和前1h阿托品用量均明显提高,而皮肤干燥的比率则明显降低,差别均具有统计学意义（P〈0．05）。结论对于急性有机磷中毒救助过程中继发阿托品中毒是可以预防和减少的,应积极采取相关措施,明确阿托品反应低下以及阿托品化不明显的原因,力争做到及时发现和对症治疗。     

早期血液灌流在急性有机磷农药中毒患者治疗中的经济学评价

目的 从经济学方面对急性有机磷农药中毒治疗中的早期血液灌流技术进行评价.方法 40例急性有机磷农药中毒患者根据是否行早期血液灌流分为早期灌流组（20例）和对照组（20例）.观察两组患者在基础情况、治疗和预后情况以及治疗费用方面的差别.结果 两组在性别构成、年龄、初始胆碱酯酶（ChE）水平、中毒程度方面比较差异无统计学意义（P＞0.05）.两组患者在病程中均接受了至少1次血液灌流治疗.早期灌流组和对照组开始血液灌流时间分别为（1.6±0.9）h和（6.4±3.6）h,两组比较差异有统计学意义（P＜0.05）.早期灌流组ChE恢复正常时间和住院时间短于对照组[（8.5±2.1）d比（10.0±1.8）d、（10.5±4.2）比（12.3±5.4）d],差异有统计学意义（P＜0.05）.早期灌流组再次血液灌流5例,机械通气4例,对照组分别为8、5例,早期灌流组无院内死亡及28 d死亡,对照组院内死亡1例,28 d死亡1例.早期灌流组总住院费用、每天治疗费用、监护费用及药品费用均低于对照组[（17 231.75±5 411.45）元比（21 394.52±6 049.81）元、（1 412.25±169.33）元比（1 579.41±307.19）元、（4 309.22±1 490.12）元比（5 581.71±1 681.00）元、（8 223.41±1 426.10）元比（9 790.02±1 909.24）元],差异有统计学意义（P＜0.05）.结论 对于急性有机磷农药中毒患者,在病程早期实施血液灌流对其预后有益,缩短了血ChE恢复正常时间和住院时间,且降低了总住院费用.     

急性有机磷农药中毒致大鼠肌无力的实验研究

目的探讨急性有机磷中毒致肌无力的机制。方法以乐果作为受试物,建立染毒后肌无力大鼠模型,测定血液、脑组织、肌肉组织胆碱酯酶（ＡＣｈＥ）活力。结果腹腔注射乐果后,大鼠全血、红细胞、血浆ＡＣｈＥ活力持续下降,至２４小时时,这三部分血液成分的ＡＣｈＥ活力分别由染毒前的（２３．４±４．６）μｍｏｌ／Ｌ、（１８．７±３．４）μｍｏｌ／Ｌ、（６．０±１．１）μｍｏｌ／Ｌ降至（２．１±１．６）μｍｏｌ／Ｌ、（１．５±１．１）μｍｏｌ／Ｌ、（０．８±０．５）μｍｏｌ／Ｌ。大鼠肌无力表现与血液ＡＣｈＥ活力变化不平行,二者相关程度较低（ｒ＝０．６４,Ｐ＞０．０５）。大鼠发生肌无力时,中枢及外周组织ＡＣｈＥ活力亦显著下降,但不同组织中ＡＣｈＥ活力下降的程度及趋势各不相同。肌肉组织与血液ＡＣｈＥ活力变化趋势较为一致。结论ＡＣｈＥ持续抑制可能不是肌无力的主要原因,其在肌无力发病中的意义需进一步研究。     

Central and peripheral nervous system effects of hand-arm vibrating tool operation

Summary To examine the effects of hand-arm vibrating tool operation on the central and peripheral nervous system, the brainstem auditory-evoked potential (BAEP), median nerve conduction velocity and hearing level were measured in twelve chain saw operators (6 operators had a history of white finger attack) and in eight brush saw operators (none had a history of the attack). Control subjects, matched to each chain saw and brush saw operator by sex and age, were selected randomly from healthy adults without otitis, deafness and tinnitus. The I–V interpeak latency (conduction from cochlear nerve to brainstem) and V peak latency of BAEP were significantly prolonged in chain saw operators; the I–V interpeak latency was significantly correlated with working years in brush saw operators. The median nerve conduction velocity was significantly slowed in both chain saw and brush saw operators. Moderate hearing loss was observed in the two groups. It is suggested that vibrating tool operation, i. e. the combined stressors of local vibration, noise, climate and heavy work, affected not only the peripheral nervous system but also the brainstem portion of the auditory pathway; the brainstem effect, if any, is less advanced than the peripheral nervous system effect of local vibration.     

哈伯因对急性有机磷中毒神经损伤的保护作用研究

目的观察哈伯因(HupA)对急性水胺硫磷和辛硫磷中毒的神经病理改变和神经递质谷氨酸(Glu)和nNOS表达的影响。方法选取成年雄性昆明小鼠,分为3组:空白对照组、染毒组、HupA组,每组20只。染毒组和HupA组动物分别经口染毒水胺硫磷(14.7mg/kg)或辛硫磷(1702mg/kg),治疗组染毒前2h经口给予HupA(0.5mg/kg),空白对照组给予吐温-80。染毒24h后处死动物,取出大脑,按大脑冠状切面进行选块、切片,一部分做甲苯胺蓝染色;一部分进行免疫组织化学检查,供检测脑皮质、海马组织的Glu和nNOS使用。结果染毒组病理学检查尼氏小体数量减少,染色变浅,而HupA组尼氏小体改变明显减轻。水胺硫磷中毒小鼠脑组织中Glu阳性细胞减少(P<0.01),nNOS阳性细胞增多(P<0.01)。与染毒组比较,HupA组Glu阳性细胞面积显著增多(P<0.01),海马区nNOS阳性面积显著减少(P<0.01)。辛硫磷染毒组未见改变。结论 HupA对水胺硫磷急性中毒引起的神经损伤有一定得保护作用,对辛硫磷急性中毒引起的神经递质改变无显著影响。     

有机磷中毒患者血浆内皮素和一氧化氮水平的变化

通过观测正常人和有机磷中毒(AOPP)患者血浆内皮素(ET)和一氧化氮(NO)水平,探讨ET和NO在AOPP发病过程中的变化及意义。结果发现AOPP轻度组与对照组比较无显著变化,中度和重度组与对照组相比,ET和NO均显著升高,且ET、NO与AChE之间呈显著负相关。提示AOPP患者血浆ET和NO的含量变化与中毒程度有关,可作为判断预后和中毒程度的指标。     

苯海索在重症急性有机磷农药中毒患者救治中的应用

目的 探讨苯海索对重症有机磷农药中毒并发肌张力增高患者的影响。
方法 选择重症有机磷农药中毒并发肌张力增高患者70例, 随机分为治疗组(36例)和对照组(34例)。对照组常规给予洗胃、特殊解毒药、对症及支持治疗。治疗组患者在对照组治疗的基础上, 同时给予苯海索3次/d, 每次2 mg, 疗程3~31 d。
结果 治疗组患者呼吸衰竭发生率为19.5%, 迟发性神经病发生率为5.6%, 各低于对照组的70.6%、50.0%, 差异均有统计学意义(P < 0.01);治疗组死亡率为2.7%, 低于对照组的14.7%, 但差异无统计学意义(P>0.05)。治疗组存活患者平均住院时间为(15.9 ±3.0) d, 短于对照组存活患者的(27.3 ±3.6) d, 差异有统计学意义(P < 0.01)。
结论 苯海索对重症有机磷农药中毒并发肌张力增高患者疗效较好, 值得推广。
     

30例急性有机磷农药中毒患者经颅多普勒超声检查分析

目的 探讨急性有机磷农药中毒(AOPP)轻、中、重度患者脑血流灌注变化的规律.方法 回顾分析30例AOPP患者双侧大脑中动脉(MCA)血流频谱形态和血流动力学参数.结果 12例轻度AOPP患者中9例收缩期峰值流速(Vp)、舒张末期流速(Vd)、平均流速(Vm)增高,患者搏动指数(PI)、阻力指数(RI)基本正常;12例中度AOPP患者Vp、Vm、Vd均中度下降,PI、RI均升高;6例重度AOPP患者Vm、Vd明显下降,PI、RI明显升高;大部分患者频谱形态出现异常.结论 经颅多普勒超声检查能够对AOPP患者提供丰富的脑血流动力学资料,为患者的病情评估、预后和科研提供可靠的依据,具有重要的临床和科研意义.     

急性有机磷农药中毒迟发性神经病的影响因素

对257例有机磷中毒患者的随访分析表明,急性有机磷农药中毒后迟发性多发性神经病的发生与患者的中毒剂量、中毒农药种类、有无中间肌无力综合征(IMS)发生、中毒程度、有无前期抢救等因素有关.