血液灌流抢救重度急性有机磷中毒的疗效观察

目的：探讨血液灌流（HP）抢救重度急性有机磷农药中毒（AOPP）的疗效及影响因素。方法：将64例重度AOPP病人随机分为观察组和对照组各32例，观察组在常规治疗基础上行血流灌流治疗，对照组按常规治疗，观察两组病人的治疗效果。结果：观察组清醒时间和达阿托品化的时间缩短，血清胆碱脂酶（ChE)恢复活力时间明显较对照组缩短（P＜0．05）；阿托品用量较对照组减少1／3（P＜0．05）；观察组痊愈27例，自动出院5例，痊愈率与对照组比较，差异有显著性意义（P＜0．05）。结论：重度AOPP病人在常规治疗的同时，早期给予HP治疗可提高抢救成功率。     

血液灌流抢救重度急性有机磷中毒的疗效观察和护理体会

目的 探讨血液灌流（HP）抢救重度急性有机磷中毒（AOPP）的临床疗效及护理。方法 将确诊为重度AOPP的106例患者随机分为治疗组和对照组,均给予清除毒物、解毒及对症支持等常规内科治疗,治疗组同时给予HP治疗,观察两组患者的临床疗效及不良反应。结果 治疗组总治愈率92.59%,与对照组比较差异具有统计学意义（71.15%,P〈0.01）,且未出现明显不良反应。结论 HP抢救重度AOPP患者,疗效满意,安全性好,值得临床推广。     

临床药师在急性有机磷中毒患者治疗中的药学监护

目的探讨临床药师在急性有机磷中毒患者的药学监护点,为急性有机磷中毒患者用药提供参考。方法临床药师通过参与急性有机磷中毒患者治疗用药方案的制定,从药物的选择、给药剂量及不良反应预计等方面,提出药学观点。结果治疗后,患者逐步恢复正常,未出现进一步的阿托品中毒,肝损害症状得到有效控制。结论临床药师参与急性有机磷中毒患者的临床治疗过程,使患者获益,提高了临床治疗水平。     

人的基因工程氨酰基脯氨酸二肽酶的多效酶活性(英文)

目的　研究人氨酰基脯氨酸二肽酶除催化水解C端为脯氨酸残基的二肽外 ,是否还有G类有机磷化合物水解酶 (G酶)活性。方法　用基因工程技术克隆及表达人的重组氨酰基脯氨酸二肽酶。氨酰基脯氨酸二肽酶及G酶活性用常规方法测定。结果　COS 7细胞表达的人氨酰基脯氨酸二肽酶催化有机磷化合物梭曼的水解 ,也水解二肽化合物Gly Pro。两种活性比未转染的COS 7细胞高 2倍。比较转染了带有氨酰基脯氨酸二肽酶基因的重组载体的COS 7细胞和对照组细胞中的两种酶活性 ,可以看到有平行的升高趋势及恒定的酶活性比值。结论G酶和氨酰基脯氨酸二肽酶为同一个酶 ,或至少属于同工酶     

南京某医院急症医学中心收治的重症中毒病例分析

目的：了解大型综合性医院急救中心重症中毒病例的发病原因、特征、抢救治疗效果．以总结经验和教训,探讨中毒防治的策略。方法：对南京某三级综合性医院急症医学中心1988年1月～2004年6月收治的全部重症中毒病例进行回顾性分析。结果：该中心16年问共收治重症中毒患者502例,涉及毒物6类,43种,主要是农药中毒和一氧化碳中毒,分别占40．44％,18．92％。1988年发病最多,占16．73％;2003年中毒患者最少,占1．39％。农药中毒以有机磷为主,春夏秋季高发;一氧化碳中毒为冬季高发。患者男女比例1：1．15;21～40岁是中毒的高发人群,占55．98％。职业分布以工人为主．占42．22％;其次是农民,占32．06％。72．71％的患者治愈．7．37％死亡。结论：南京地区中毒的发生具有明显的季节、中毒源、年龄及性别特征,病死率高,须引起重视,并要加强宣传教育,采取有效防范措施．以减少中毒的发生。     

Plant-derived human butyrylcholinesterase, but not an organophosphorous-compound hydrolyzing variant thereof, protects rodents against nerve agents

The concept of using cholinesterase bioscavengers for prophylaxis against organophosphorous nerve agents and pesticides has progressed from the bench to clinical trial. However, the supply of the native human proteins is either limited (e.g., plasma-derived butyrylcholinesterase and erythrocytic acetylcholinesterase) or nonexisting (synaptic acetylcholinesterase). Here we identify a unique form of recombinant human butyrylcholinesterase that mimics the native enzyme assembly into tetramers; this form provides extended effective pharmacokinetics that is significantly enhanced by polyethylene glycol conjugation. We further demonstrate that this enzyme (but not a G117H/E197Q organophosphorus acid anhydride hydrolase catalytic variant) can prevent morbidity and mortality associated with organophosphorous nerve agent and pesticide exposure of animal subjects of two model species.     

经皮和经口途径有机磷农药中毒后胆碱酯酶活性与中毒程度的不对等性比较

目的总结经皮和经口有机磷农药中毒的治疗经验。方法同期观察全血胆碱酯酶活性低于0．50的34例经皮途径（经皮组，中度19例，重度15例）和50例经口途径（经口组，中度22例，重度28例）有机磷农药中毒患者的临床表现，比较同等中毒程度时两组胆碱酯酶活性的变化以及阿托品用量的差异。结果同等中毒程度时，治疗前两组胆碱酯酶活性差异无显著性（P均〉0．05），但经皮组中毒症状明显轻于经口组。治疗后24、48和72h胆碱酯酶活性测定值经皮组明显高于经口组（P〈0．05或P〈0．01）。经皮组阿托品化用量及阿托品总量明显少于经口组，且解毒治疗时间也明显短于经口组（P均〈0．01）。结论胆碱酯酶活性相同情况下，经皮有机磷农药中毒患者的临床症状轻于经口有机磷农药中毒者，阿托品用量明显少于经口有机磷农药中毒者，胆碱酯酶活性的恢复经皮中毒患者先于经口有机磷农药中毒患者。     

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.     

An automated method for the determination of acetyl and pseudo cholinesterase in hemolyzed whole blood.

The aim of the present study was to develop a method which allows determination of pseudo (PsChE) and acetyl cholinesterase (AChE) activities in single hemolyzed blood samples of workers exposed to cholinesterase-inhibiting compounds, avoiding the time-consuming and laborious separation of plasma and erythrocytes. Two methods based on Ellman's colorimetric determination of cholinesterase activity were compared, and three different substrates were tested. The best results were obtained with the substrates butyrylthiocholine and acetyl(beta-methyl)thiocholine, both showing a substrate specificity of more than 97% with respect to PsChE and AChE, respectively. The method showed sensitivity to detect low levels of inhibition of AChE and PsChE in blood. The between-day precision was less than 4% for both cholinesterase activities. It was demonstrated with this method that hemolyzed blood can be stored at -20 degrees C at least 18 months without loss of cholinesterase activity. The method has been used for 18 months in a monitoring program for laboratory employees working with various cholinesterase-inhibiting compounds. The average co-efficients of intraindividual variation amounted to 6.8% (range 2.2-9.6%; 90 percentile, 8%) and 6.6% (range 2.9-9.9%; 90 percentile, 7.9%) for PsChE and AChE, respectively. In a group of non-exposed workers the average intraindividual variations were 4.0% (range 1.5-7.7%; 90 percentile, 7.6%) and 3.6% (range 0.6-6.6%; 90 percentile, 5.3%), respectively. Using the value of 4.0%, it appears possible to detect an individual decrease in cholinesterase activity of more than 8% below a baseline based on three determinations. The method can thus be used to detect relatively low levels of cholinesterase inhibition.     

Impact of Organophosphorous Pesticide Exposure on Semen Quality

Objective To investigate the impact of organophorous pesticide exposure on semen quality and other risk factors of semen quality Method Questionnaire investigation, external genital examination and laboratory examination of semen quality were conducted on 322 subjects, who were divided into exposed and control group, each consisting of 161 subjects. Results Multivariate analysis showed that educational level and years of alcohol drinking had effect on semen volume. Compared with subjects with primary school education or lower, those with junior high school education had higher value of semen volume (OR= 1. 961). Proportion of subjects with high semen volume decreased with the increasing years of alcohol drinking (OR = 0. 962). Organophosphorous pesticide exposure could result in the decline of the number of sperms with progressive forward progression (OR = 0. 528), figure of semen density (OR = 0. 266), semen viatbility(OR = 0. 398) and percentage of normal sperm morphology (OR = 0. 281). There are possible relationships between the season of semen collection and the number of sperms with progressive forward progression, semen viability and percentage of normal sperm morphology. Compared to summer, values of the above three indices would be higher in winter (OR was 2. 272, 4. 060 and 5. 249, respectively). Conclusion Exposure to organophosphorous pesticide could result in the deterioration of semen quality of the peasants.