急性百草枯中毒严重程度的早期评估及预后

急性百草枯中毒(APP)死亡率高,可引起多器官功能障碍甚至衰竭,临床治疗方案常采用多项措施联合的集束化治疗。故在患者就诊早期即对APP严重程度进行评估,能够为临床治疗方法的选择提供指导,对启动不同级别的治疗措施和预后改善都具有重要的临床价值。本文就早期评估APP严重程度及预后的研究进展做一述评。     

Efficiency of anisodamine for organophosphorus-poisoned patients when atropinization cannot be achieved with high doses of atropine

Poisoning by organophosphorus insecticides is a major global public health problem. Although atropine has been widely used to treat organophosphate (OP) poisoning, sometimes atropinization cannot be achieved, even with high doses of atropine. Hence, we aimed to assess the effect of anisodamine for organophosphorus poisoned patients for whom atropinization could not be achieved through high doses of atropine. In this study, sixty-four OP-poisoning patients, all of whom accepted routine treatments but who did not attain atropinization after high doses of atropine for 12 h, were enrolled. The result showed that the time to atropinization was 24.3 ± 4.3 h in the anisodamine group, significantly shorter than in the atropine group (29.2 ± 7.0 h, p < 0.05); the hospital stay in the anisodamine group was 5.3 ± 2.5 days, significantly shorter than the 6.9 ± 2.3 days needed by the atropine group (p < 0.05). We draw a conclusion that anisodamine can shorten the process of atropinization and hospital stay in organophosphorus poisoned patients for whom atropinization cannot be achieved with high doses of atropine.     

Assessment of blood 2-aminothiazoline-4-carboxylic acid concentrations: Age and sex differences,and correlation with carboxyhemoglobin in fire victims

Recently, 2-aminothiazoline-4-carboxylic acid (ATCA), a cyanide (CN) metabolite, has been proposed as a stable diagnostic marker of CN poisoning. In this study, liquid chromatography coupled with electrospray ionization – tandem mass spectrometry was used to quantify ATCA concentrations in human postmortem blood samples, and differences in ATCA concentrations according to age and sex were determined. Both age and sex had significant effects on blood ATCA concentrations. Although ATCA concentrations exhibited an inverted U shape with increasing age in men, in women ATCA concentrations plateaued at around 40–59 years of age. There were significant differences between the sexes in ATCA concentrations for the 20–39 and 40–59 year age groups (P < 0.05 and P < 0.01, respectively). Correlations between ATCA concentrations and carboxyhemoglobin (CO-Hb) saturation were also examined in fire victims. ATCA concentrations increased significantly with increasing CO-Hb saturation (r = 0.382, P < 0.01). In addition, ATCA concentrations were also correlated to CN concentrations (r = 0.309, P < 0.05). The results of our study may provide novel information about the contribution of CN poisoning to the cause of death at fire scenes.     

床边血液灌流治疗急性有机磷农药中毒的研究分析

目的：探讨床边血液灌流治疗急性有机磷农药中毒的临床效果。方法选取本院ICU 2011年1月~2014年10月收治的急性有机磷农药中毒患者60例，随机分为实验组和对照组，对照组给予常规治疗，实验组在常规治疗的基础上加用床边血液灌流治疗，比较两组患者的昏迷时间、呼吸机脱机时间、阿托品用量、血清胆碱酯酶(CHE)恢复时间、住院时间以及并发症发生率和治愈率。结果实验组患者昏迷时间、呼吸机脱机时间、CHE恢复时间及住院时间均短于对照组，阿托品用量少于对照组，差异有统计学意义(P<0.05)。实验组并发症发生率为10.0%，低于对照组的30.0%，差异有统计学意义(P<0.05)。实验组治愈率为93.3%，高于对照组的76.7%，差异有统计学意义(P<0.05)。结论在常规阿托品等药物治疗的基础上加用床边血液灌流治疗急性有机磷农药中毒可快速改善患者的临床症状，提高治愈率，降低病死率。     

姜黄素治疗急性百草枯中毒的临床研究

目的:探讨姜黄素治疗急性百草枯口服中毒的临床疗效。方法:选择2007年3月-2010年3月在院救治的急性百草枯口服中毒患者74例,分为常规治疗组、激素治疗组和姜黄素治疗组。3组均常规对症治疗,激素治疗组在此基础上给予地塞米松25mg,静脉注射,每日1次。姜黄素治疗组在此基础之上给予姜黄素500mg/kg,口服,每日1次。在治疗第3天、7天、21天进行疗效评价,并对各组患者所出现的并发症进行统计。常规治疗组、激素治疗组和姜黄素治疗组均根据服毒量分组比较(20%原液或相当量<50ml组和≥50ml组)。结果:中毒治疗第3天,7天,21天,各组相比较,激素治疗组和姜黄素治疗组存活率均明显比常规治疗组高(均P<0.05),而姜黄素治疗组生存率与激素治疗组相比差异无统计学意义(P>0.05)。各组并发症发生率,即肺纤维化、急性肾功能衰竭、肝功能衰竭、MODS、DIC等并发症在激素治疗组和姜黄素治疗组均明显低于常规治疗组(均P<0.05),而激素治疗组与姜黄素治疗组之间比较差异无统计学意义(P>0.05)。结论:对急性百草枯口服中毒患者给予姜黄素治疗,其存活率和严重并发症发生率得到一定程度的改善,初步显示较好的疗效。     

Hydroxocobalamin in cyanide poisoning

Introduction. On theoretical grounds, hydroxocobalamin is an attractive antidote for cyanide poisoning as cobalt compounds have the ability to bind and detoxify cyanide. This paper reviews the pharmacokinetic and pharmacodynamic aspects of hydroxocobalamin, its efficacy in human cyanide poisoning and its adverse effects. Methods. PubMed was searched for the period 1952 to April 2012. A total of 71 papers were identified in this way; and none was excluded. Pharmacokinetics and pharmacodynamics. Pharmacokinetic studies in dogs and humans suggest a two-compartment model, with first order elimination kinetics. Pharmacodynamic studies in animals suggest that hydroxocobalamin would be a satisfactory antidote for human cyanide poisoning. Efficacy in human poisoning. There is limited evidence that hydroxocobalamin alone is effective in severe poisoning by cyanide salts. The evidence for the efficacy of hydroxocobalamin in smoke inhalation is complicated by lack of evidence for the importance of cyanide exposure in fires and the effects of other chemicals as well as confounding effects of other therapeutic measures, including hyperbaric oxygen. Evidence that hydroxocobalamin is effective in poisoning due to hydrogen cyanide alone is lacking; extrapolation of efficacy from poisoning by ingested cyanide salts may not be valid. The rate of absorption may be greater with inhaled hydrogen cyanide and the recommended slow intravenous administration of hydroxocobalamin may severely limit its clinical effectiveness in these circumstances. Adverse effects. Both animal and human data suggest that hydroxocobalamin is lacking in clinically significant adverse effects. However, in one human volunteer study, delayed but prolonged rashes were observed in one-sixth of subjects, appearing 7 to 25 days after administration of 5 g or more of hydroxocobalamin. Rare adverse effects have included dyspnoea, facial oedema, and urticaria. Conclusions. Limited data on human poisonings with cyanide salts suggest that hydroxocobalamin is an effective antidote; data from smoke inhalation are less clear-cut. Although clinically important reactions to hydroxocobalamin have not been seen, some, non-life threatening, adverse reactions can occur.     

Antioxidant treatment and outcome of cortinarius orellanus poisoning: a case series

Abstract

Objectives: To study the frequency, severity, and long-term outcome of renal injury in Cortinarius orellanus poisoning, to evaluate the association between the ingested amount of C. orellanus and outcome, and to evaluate the effect of N-acetylcysteine and corticosteroid treatment on outcome. Methods: Case series of eight patients. Diagnosis and severity of acute kidney injury (AKI) and chronic kidney disease (CKD) were classified according to current AKI and CKD definitions. N-acetylcysteine and corticosteroids were administered to six patients, former according to the standard for paracetamol poisoning. Main findings: All patients developed AKI, six in the most severe stage and four required renal replacement therapy (RRT). After 12 months, seven patients presented with CKD, of whom three required chronic RRT and further two were in advanced CKD. AKI and CKD severity highly correlated with the consumed amounts of Cortinarius orellanus (r?=?0.98, p?<?0.001 and r?=?0.78, p?=?0.02, respectively) but not with N-acetylcysteine and corticosteroid treatment. Conclusions: AKI and CKD by current definitions and classifications are frequent and severe after Cortinarius orellanus poisoning. The ingested amount of Cortinarius orellanus correlates with the severity of both AKI and CKD. N-acetylcysteine and corticosteroid treatment do not seem to have a beneficial effect on either AKI or CKD.