Management of acute organophosphorus pesticide poisoning

Organophosphorus pesticide self-poisoning is an important clinical problem in rural regions of the developing world, and kills an estimated 200,000 people every year. Unintentional poisoning kills far fewer people but is a problem in places where highly toxic organophosphorus pesticides are available. Medical management is difficult, with case fatality generally more than 15%. We describe the limited evidence that can guide therapy and the factors that should be considered when designing further clinical studies. 50 years after first use, we still do not know how the core treatments--atropine, oximes, and diazepam--should best be given. Important constraints in the collection of useful data have included the late recognition of great variability in activity and action of the individual pesticides, and the care needed cholinesterase assays for results to be comparable between studies. However, consensus suggests that early resuscitation with atropine, oxygen, respiratory support, and fluids is needed to improve oxygen delivery to tissues. The role of oximes is not completely clear; they might benefit only patients poisoned by specific pesticides or patients with moderate poisoning. Small studies suggest benefit from new treatments such as magnesium sulphate, but much larger trials are needed. Gastric lavage could have a role but should only be undertaken once the patient is stable. Randomised controlled trials are underway in rural Asia to assess the effectiveness of these therapies. However, some organophosphorus pesticides might prove very difficult to treat with current therapies, such that bans on particular pesticides could be the only method to substantially reduce the case fatality after poisoning. Improved medical management of organophosphorus poisoning should result in a reduction in worldwide deaths from suicide.     

有机磷农药中毒致心律失常分析

目的：观察有机磷农药中毒对患的心电图的影响及其在心律失常的发生,发展中所起的作用。方法：对32例重度有机磷农药中毒患及28例轻,中度患进行临床心电观察比较。结果：重度有机磷中毒患出现心律失常,与轻,中度中毒患比较,在统计学上有非常显性差异（P＜0．01）,心律失常形式呈多样化,既有室性心律失常,也有室上性：既有快速型心律失常,也有缓慢型。结论：对重度有机磷农药中毒引起的多种类型心律失常,应密切观察,及时发现,及时处理,绝大部分病人经治疗,心律失常可纠正。     

口服解磷定辅治急性有机磷农药中毒

目的观察口服解磷定对急性重症有机磷农药中毒的疗效。方法随机将162例重度急性有机磷中毒患者分为对照组和治疗组，治疗组在常规治疗同时给予口服解磷定。结果口服解磷定可减少阿托品用量，加快阿托品化，尽早恢复胆碱酯酶活力，缩短住院天数，减少反跳数和中间综合征的发生，提高治愈率。结论口服解磷定能有效治疗急性有机磷中毒。     

急性有机磷中毒193例临床分析

目的:探讨急性有机磷中毒(AOPP)所致呼吸衰竭(呼衰)、心力衰竭(心衰)以及重度AOPP合并血清淀粉酶升高的危险因素.方法:193例AOPP患者按毒物种类、中毒程度分组,比较各组间呼衰、心衰发生情况有无差异;分析中毒24h内血清胆碱酯酶(CHE)水平与呼衰、心衰的相关性,重度中毒患者血清淀粉酶升高的危险因素.结果:毒物种类对患者呼衰、心衰影响无统计学差异;重度中毒组呼衰、心衰发生率较轻、中度组明显升高(均P＜0.05);呼衰组和心衰组血清CHE水平均明显低于非呼衰组和非心衰组(均P＜0.05);敌敌畏中毒和中毒24 h内血清CHE水平与血清淀粉酶水平存在一定相关性.结论:中毒程度和血清CHE水平可作为AOPP呼衰、心衰发生的预测指标;敌敌畏中毒和血清CHE水平明显降低是重度AOPP患者血清淀粉酶升高的2个危险因素.     

胆碱酯酶特征与急性有机磷农药中毒的临床联系

胆碱酯酶 (ＣｈＥ)系指正常ＣｈＥ和有机磷农药与ＣｈＥ结合所生成的磷酰化酶 (中毒酶 )而言。它们各有自己的特征。临床中 ,常因对这些特征认识不足 ,而对一些临床现象难以解释 ,用药时易忽视复能剂的使用 ,不能抓住急救治疗有利时机和掌握中毒程度、诊治指标等 ,从而影响了治疗效果。本研究将围绕着ＣｈＥ特征和临床体会 ,论述与急性有机磷农药中毒 (ＡＯＰＰ)的联系 ,旨在最终能提高对ＡＯＰＰ的救治水平。一、ＣｈＥ的分类、分布特征体内正常ＣｈＥ分为 :真性ＣｈＥ ,即乙酰胆碱酯酶(ＡＣｈＥ)和假性ＣｈＥ。假性ＣｈＥ包括丁酰ＣｈＥ(…     

急性有机磷农药中毒患者血浆内皮素的变化及临床意义

目的　探讨急性有机磷农药中毒 (AOPP)患者血浆内皮素 (ET)的变化及其临床意义。方法　将 6 9例AOPP患者分成轻度、中度、重度中毒组 3组 ,另选取 2 5例健康人为正常对照组 ,各组均采用放射免疫法检测血浆ET含量。同时进行对比分析。结果　AOPP轻度中毒组患者血浆ET的含量 (5 6 18± 12 80 )ng/L仅轻度升高 ,与正常对照 (5 0 85± 8 93)ng/L比较 ,差异无显著性 (P >0 0 5 ) ;中度、重度中毒组患者血浆ET含量分别为 :(72 6 1± 14 2 1)ng/L ,(110 32± 17 38)ng/L较正常对照组明显升高 (P均 <0 0 1) ,中度中毒组患者血浆ET含量较轻度中毒组明显升高 (P <0 0 1) ;重度中毒组患者血浆ET含量较中度中毒组明显升高 (P <0 0 1)。结论　随着AOPP中毒程度的加重 ,血浆ET含量逐渐上升 ,血浆ET的检测可作为判断AOPP患者病情轻重、治疗效果及预后的参考指标     

130例重度急性有机磷农药中毒患者心电图变化转归分析

目的：探讨重度急性有机磷农药中毒（ acute organophosphorus pesticide poisoning , AOPP）患者心电图变化转归的特点。方法收集130例重度AOPP住院患者的心电图资料,观察心电图的变化转归并复习相关文献。结果130例重度AOPP患者中心电图异常者124例,占95．38％。常见的心电图变化有窦性心动过速、早搏和传导阻滞等各种心律失常、ST-T段以及QT间期的改变等;随病情好转,大多数可恢复正常。结论重度AOPP可引起心律失常等各种心电图变化,与心肌损害和缺血有关,然而随病情好转大多可逐渐恢复正常。     

呼吸机在有机磷农药中毒中间综合征中的应用

目的探讨呼吸机机械通气在急性有机磷农药中毒(AOPP)救治过程中出现中间综合征(IMS)后的应用价值。方法回顾性分析我科收治的124例急性有机磷农药中毒(AOPP)患者中36例出现中间综合征后采用呼吸机机械通气治疗的有效性。结果 36例中间综合征(IMS)患者均采用有创机械通气,30例存活,6例死亡,死亡率16.7%。结论对于急性有机磷农药中毒(AOPP)患者,早期识别中间综合征(IMS),早期行呼吸机辅助机械通气治疗是抢救成功的关键,可明显降低死亡率。     

长托宁联合血液灌流治疗急性重度有机磷农药中毒的临床分析

目的 观察长托宁联合血液灌流治疗急性重度有机磷农药中毒(AOPP)的疗效.方法 43例经口服重度AOPP患者随机分为2组,阿托品联合血液灌流组(A组,21例)和长托宁联合血液灌流组(B组,22例),通过观察患者的给药次数、总药量、血液灌流次数、治愈率、平均住院天数及不良反应发生率比较两种方法的临床疗效.结果 B组给药次数、总药量、血液灌流次数、不良反应、平均住院天数均明显少于A组(P＜0.05).结论 长托宁联合血液灌流在抢救治疗急性重度有机磷农药中毒的疗效优于阿托品联合血液灌流,且副作用更少.     

库存血胆碱酯酶水平变化在重症有机磷农药中毒抢救中应用选择

目的 观察库存血保存天数与血浆胆碱酯酶（ＣＨＥ）水平变化关系,探讨急性重症有机磷农药中毒（ＡＯＰＰ）抢救中合理选择,用于换血疗法或者输血的血源。方法 输血前随机留取保留不同天数的库血测定血浆ＣＨＥ值;血液中心采血当日留取正常人血浆、即日测定ＣＨＥ值作对照组。ＣＨＥ测定用ＢＭ公司的胆碱酯酶试剂盒,Ｒｏｃｈ公司的Ｃｏｂａｓ－ＦａｒａⅡ自动分析仪测定。结果 库存血保存天数为第一天的血浆ＣＨＥ值与正常对     

机械通气治疗急性重度有机磷农药中毒并呼吸衰竭的临床研究

目的 探讨机械通气在急性重度有机磷农药中毒( ASOPP)并呼吸衰竭患者救治中的临床价值.方法 分析2003年5月至2010年12月收治的ASOPP合并呼吸衰竭患者92例,其中机械通气治疗组(A组)47例,未行机械通气治疗组(B组)45例,比较两组住院时间及临床疗效.结果 A组住院时间明显短于B组(P＜0.01),而临床疗效显著高于B组(P＜0.01).结论 机械通气是救治ASOPP并呼吸衰竭的重要方法,能显著提高临床治愈率,缩短住院时间.     

长托宁联合N6环戊基腺苷救治急性有机磷农药中毒临床观察

目的:探讨长托宁联合应用N6环戊基腺苷(CPA)治疗急性有机磷农药中毒(AOPP)的临床疗效。方法:将40例中、重度AOPP患者随机分为治疗组和对照组(各20例),长托宁联合CPA救治患者为治疗组;单用长托宁救治患者为对照组。分析比较2组长托宁首次量、追加量、用药总量、胆碱脂酶(CHE)上升时间、达长托宁化时间、长托宁不良反应发生率。结果:治疗组长托宁首次用药量、追加量及用药总量比对照组明显减少(均P0.05),长托宁不良反应发生率明显低于对照组(P0.05),"长托宁化"时间及"CHE上升"时间明显短于对照组(P0.05)。结论:长托宁联合CPA治救AOPP,能合理减少长托宁用量,迅速达到或维持"长托宁化",显著减少长托宁不良反应发生率。     

突击量氯磷定治疗急性有机磷农药中毒致呼吸肌麻痹76例观察

目的 比较突击量与非突击量氯磷定方案对急性有机磷农药中毒（ＡＯＰＰ）致呼吸肌麻痹（ＲＭＰ）的治疗效果。方法 对７６例ＡＯＰＰ致ＲＭＰ闰人,根据救治时头３ｄ是否应用突击量氯磷定方案或近似突击量氯磷定方案,将病人分为两组。Ａ组３０例,平均年龄２８．９岁。每天氯磷定用量≥１０．０ｇ,平均１１．４ｇ。Ｂ组病人４６例,平均年龄３０．７岁。每天氯磷定用量〈１０．０ｇ,平均６．３ｇ。结果 Ａ组病人自主呼吸恢复时     

饭后口服有机磷农药中毒两种洗胃方法效果的比较

目的：探讨饭后口服急性有机磷农药中毒（acute organic phosphorus poisoning,AOPP)适宜的洗胃方法。方法：42例饭后口服AOPP患随机分为两组，观察组22例，对照组20例。观察组立即给予剖腹洗胃，对照组立即给予插管洗胃。结果：观察组平均每人阿托品用量600mg，对照组平均每人阿托品用量893．6mg,对照组明显高于观察组（P＜0．05）。治愈率：观察组86．4％，对照组65％，两组间有显性差异（P＜0．05）。并发症发生率；观察组18．8％，对照组50％，两组间有显性差异（P＜0．05）。结论：饭后口服AOPP患剖腹洗有可提高治愈率，减少并发症发生率和死亡率。     

Economic burden of acute pesticide poisoning in South Korea

Objectives To investigate the magnitude and characteristics of the economic burden resulting from acute pesticide poisoning (APP) in South Korea. Methods The total costs of APP from a societal perspective were estimated by summing the direct medical and non‐medical costs together with the indirect costs. Direct medical costs for patients assigned a disease code of pesticide poisoning were extracted from the Korean National Health Insurance Reimbursement Data. Direct non‐medical costs were estimated using the average transportation and caregiving costs from the Korea Health Panel Survey. Indirect costs, incurred by pre‐mature deaths and work loss, were obtained using 2009 Life Tables for Korea and other relevant literature. Results In 2009, a total of 11 453 patients were treated for APP and 1311 died, corresponding to an incidence of 23.1 per 100 000 population and a mortality rate of 2.6 per 100 000 population in South Korea. The total costs of APP were estimated at approximately US$ 150 million, 0.3% of the costs of total diseases. Costs due to pre‐mature mortality accounted for 90.6% of the total costs, whereas the contribution of direct medical costs was relatively small. Conclusion Costs from APP demonstrate a unique characteristic of a large proportion of the indirect costs originating from pre‐mature mortality. This finding suggests policy implications for restrictions on lethal pesticides and safe storage to reduce fatality and cost due to APP.     

Risk factors for acute pesticide poisoning in Sri Lanka

This report describes the characteristics of patients with acute pesticide poisoning in a rural area of Sri Lanka and, for intentional self-poisoning cases, explores the relative importance of the different determinants. Data were collected for 239 acute pesticide-poisoning cases, which were admitted to two rural hospitals in Sri Lanka. Sociodemographic characteristics, negative life events and agricultural practices of the intentional self-poisoning cases were compared with a control group. Most cases occurred among young adults and the large majority (84%) was because of intentional self-poisoning. Case fatality was 18% with extremely high case fatality for poisoning with the insecticide endosulfan and the herbicide paraquat. Cases were generally younger than controls, of lower educational status and were more often unemployed. No agricultural risk factors were found but a family history of pesticide poisoning and having ended an emotional relationship in the past year was clearly associated with intentional self-poisoning. The presence of mental disorders could only be assessed for a subsample of the cases and controls and this showed that alcohol dependence was a risk factor. This study shows that acute pesticide poisoning in Sri Lanka is determined by a combination of sociodemographic and psychological factors. Suggestions are given for interventions that could control the morbidity and mortality due to acute pesticide poisoning in developing countries.     

微泵注入阿托品和纳洛酮治疗有机磷中毒呼吸衰竭25例

目的探讨阿托品和纳洛酮微泵持续注射治疗重度急性有机磷农药中毒呼吸衰竭的临床疗效。方法将50例有机磷农药中毒呼吸衰竭患者,按双盲法随机分为治疗组与对照组各25例;治疗组在常规治疗的基础上以阿托品+纳洛酮微泵注入,对照组采用传统阿托品间隔静脉推注法。两组患者保持阿托品化状态7～10d或更长,同时配合洗胃,使用复能剂氯磷定、解磷定,必要时采取有效携氧机械通气等内科综合治疗,观察记录两组患者阿托品用药总量、阿托品化时间、治愈时间、呼吸衰竭发生时间,死亡人数等。结果治疗组阿托品化时间、呼吸衰竭发生时间、病死率、阿托品用药总量及反跳发生率比对照组明显减少(P均0.05或0.01)。结论微泵注入阿托品及纳洛酮治疗重度有机磷农药中毒呼吸衰竭具有快速、足量、恒定、疗效快、且用药方法简单等优点。