常用解毒剂

最近，世界卫生组织（ＷＨＯ）汇同联合国环境保护署（ＵＮＥＰ）和国际劳工组织（ＩＬＯ）出版了中毒控制指南。这是一份有关１９９７年中毒控制的专题文集。其中有关解毒剂部分摘译如下，仅供参考。１解毒剂 表１和表２所列解毒剂是治疗人类急性中毒的有效药物，它们根据使用紧急程度，其供应要求可分为：Ａ．需立即供应上；Ｂ．需在２小时以内供应上；Ｃ．需在６小时以内供应上。 解毒剂的实际疗效可划分为： ①文献记载疗效好，例如在动物实验中能降低死亡率，在人类中毒病例中能降低死亡率或减少危重并发症： ②广泛使用但并未普遍认同…     

Execs' antidotes to union activity

State hospital association executives overwhelmingly support the development of educational programs on employment issues as the best strategy to counter increased union activity following the implementation of the National Labor Relations Board's hospital bargaining-unit rules, according to Modern Healthcare's fifth monthly Fax poll of state hospital association presidents.     

特效解毒剂的临床应用

中毒性疾病的治疗在对症支持治疗的基础上, 主要通过改变毒物代谢动力学和改变毒效学两条途径来实现。通过分别概述急性有机磷杀虫剂中毒、中毒性高铁血红蛋白血症、抗凝血杀鼠剂中毒、铅中毒、汞中毒的特效解毒剂治疗效果, 对特效解毒剂的临床应用现况做了分析和探讨。     

不同抗氰药物的抗氰效价评估

目的研究其他具有抗氰作用的药物能否在某些情况下替代高铁血红蛋白形成剂起到抗氰急救作用。方法SD大鼠非致死剂量氰化钾腹腔注射中毒,分成中毒对照组和4个治疗组,各治疗组分别注射4-二甲氨基苯酚、羟钴胺、二羟丙酮、硫代硫酸钠进行急救,观察动物中毒症状,并取血测血氰离子浓度和细胞色素氧化酶活力。结果动物惊厥停止时间4-二甲氨基苯酚治疗组明显要短于其他治疗组,表明其抗氰作用起效快;4-二甲氨基苯酚组和羟钴胺组对中毒后细胞色素氧化酶活力差异无显著性,且均明显优于其他治疗组和中毒对照组,表明两者均有助于氰化钾中毒后细胞色素氧化酶活力的恢复。结论在非致死剂量氰化物中毒时,羟钴胺的抗氰效价与4-二甲氨基苯酚相近。     

Effect of antidotes of the acute toxicity of methacrylonitrile

Summary When rats were exposed for 30 min to methacrylonitrile at concentrations between 3180 and 5700 ppm, the clinical symptoms observed suggested a toxic activity of metabolically formed cyanide. This is in contrast to the signs of toxicity observed in the same species after inhalation of acrylonitrile where metabolic cyanide formation plays only a minor role. The acute toxicity of methacrylonitrile could be antagonized with cyanide antidotes (4-dimethylaminophenol plus sodium thiosulfate) as well as with N-acetyl-cysteine which directly reacts with ,-unsaturated nitriles.     

Effect of potential antidotes on the acute toxicity of acrylonitrile

Summary Rats were intoxicated with lethal doses of acrylonitrile by different routes of application, and the effect of potential antidotes was studied. The cyanide antidotes 4-dimethylaminophenol plus thiosulfate showed some protective effect only after oral but not after i.p. or inhalatory acrylonitrile application. Of the sulfhydryl compounds cysteine, N-acetylcysteine, cysteamine and diethyldithiocarbamate the two antidotes cysteine and, to some lesser extent, N-acetylcysteine proved especially effective. Cysteine, at a dose of 200 mg/kg (i.p.), prevented the lethal effect of 100 mg/kg acrylonitrile (i.p.) even when given 2 h after the acrylonitrile dose. From these experiments a tentative schedule of antidote therapy for humans accidentally intoxicated with acrylonitrile is inferred which will be validated in further studies in subhuman primates.     

Availability of antidotes for the treatment of acute poisoning in Queensland public hospitals

Objective: To determine the sufficiency of stock levels of 13 antidotes in Queensland hospitals. Design: A self‐report survey was sent to 128 Queensland hospitals with acute care facilities. The stock level of the following antidotes was determined: acetylcysteine, anti‐digoxin Fab antibodies (digibind), atropine, calcium gluconate, cyanokit, desferrioxamine, flumazenil, glucagon, intravenous ethanol, methylene blue, naloxone, pralidoxime and pyridoxine. Other factors sampled were bed capacity, rural, remote and metropolitan areas classification, use of formal stock reviews by pharmacists or nurses, existence of formal borrowing agreements with other facilities for non‐stocked antidotes, distance to the nearest referral hospital and time taken to transfer antidotes from another hospital. Participants: Pharmacists or nurses responsible for maintaining antidote stocks in Queensland hospitals. Main outcome measures: Proportions of hospitals with sufficient antidote stock to treat a 70‐kg adult for four or more hours using previously published guidelines. Results: Survey response rate was 73.4%. No hospital had sufficient stock of all 13 antidotes. The proportion of hospitals with sufficient stocks varied from 0% (pyridoxine) to 68.1% (acetylcysteine). Larger hospitals had a higher frequency of sufficient antidote stocks. Only 16% of hospitals claimed to be able to acquire an antidote from another facility within 30 min. Conclusions: Most Queensland hospitals stocked some important antidotes, but few had sufficient stock to treat a 70‐kg patient or acquire an antidote within the recommended time frame of 30 min. Specific antidote stocking guidelines might be required for Queensland hospitals. A formalised program for stock rotation with rural facilities should be explored.     

Protection by spironolactone and different antidotes against acute organic mercury poisoning of rats

Summary Investigations carried out at our laboratory have shown that BAL (dimercaptopropanol) can be used, with some restrictions, in the treatment of organic mercury poisoning. Depending on the radical of the poison, the antidote has a variable effect although it has no therapeutic use at all in acute intoxication with methoxy-ethyl-mercury-chloride (MEMC). Similarly, neither d-penicillamine, nor sodium-formaldehyde-sulfoxylate proved to be effective antidotes, but treatment with estrogenic hormone could protect the renal failure induced by MEMC. The life-saving effect of spironolactone (the hormonally inactive steroid) was estimated against acute poisoning induced by six different organic mercury compounds on rats. Spironolactone proved to be effective in the case of MEMC when administered prior to poisoning.     

Application of recombinant DNA methods for production of cholinesterases as organophosphate antidotes and detectors

To develop new avenues for synthesizing novel antidotes for organophosphate poisoning and for detection of the organophosphates, we have turned to recombinant DNA methods to synthesize cholinesterases with unusual properties. For antidotal therapy we describe mutations of the native mouse and human enzymes that allow for enhanced rates of oxime reactivation. Such enzymes, when localized in the circulation, would enable the circulating cholinesterase to become a catalytic rather than simply a stoichiometric scavenger. Hence, "oxime-assisted catalysis" provides a means for scavenging the organophosphates in the circulation thereby minimizing their tissue penetration and toxicity. Accordingly, the oxime antidote or prophylactic agent has a dual action within the circulation and at the tissue level. Second, through a novel chemistry, termed freeze-frame, click chemistry, we have used organophosphate conjugates of acetylcholinesterase as templates for the synthesis of novel nucleophilic reactivating agents. Finally, acetylcholinesterase can be modified through cysteine substitution mutagenesis and attachment of fluorophores at the substitution positions. When linked at certain locations in the molecule, the attached fluorophore is sensitive to organophosphate conjugation with acetylcholinesterase, and thus the very target of insecticide or nerve agent action becomes a detection molecule for organophosphate exposure.     

Nerve conduction studies

This article forms part of our 'Tests and results' series for 2011 which aims to provide information about common tests that general practitioners order regularly. It considers areas such as indications, what to tell the patient, what the test can and cannot tell you, and interpretation of results.     

Nerve conduction studies

Nerve conduction studies provide unique quantitative information about neurological function in patients with a variety of neuromuscular disorders. This article emphasizes the need for careful selection of the appropriate procedures, informed interpretation of the data, and correlation of the results with the clinical information about each individual patient's problem, in order to obtain the maximum possible value from the investigation.