Modern strategies in therapy of organophosphate poisoning
Modern strategies in therapy of organophosphate poisoning
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DOI：
10.1016/s0378-4274(99)00052-1
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发表时间：
1999-06-30
影响因子：
3.5
通讯作者：
Zilker, T
中科院分区：
文献类型：
--
作者：
Thiermann, H;Szinicz, L;Zilker, T
考虑到有机磷中毒治疗中的各种微观反应以及毒代动力学和药代动力学原理，奥比肟采用初始大剂量后持续输注的给药方式是合理的。采用该方案，对6例对硫磷或甲基氧美敦中毒患者进行治疗。对硫磷中毒7天后仍有可能恢复活性。在对氧磷浓度为>.1 μ M时，奥比肟在体内只能部分激活红细胞的乙酰胆碱酯酶（AChE），但在体外可以评估其再激活情况，这与理论计算大致吻合。疼痛抑制物质检测至5天。当AChE高于正常值20%时，胆碱能症状迅速消退，阿托品血药浓度可维持在7 ng/ml以下。一名患者的脑损伤持续存在。氧德美敦甲基中毒对奥比多肟治疗只有在中毒后不久才有反应。六名病人中有一人死亡。12例患者无中间综合征，无永久性肝功能障碍征象。1999爱思唯尔科学爱尔兰有限公司版权所有。
Considering the various microscopic reactions as well as toxicokinetic and pharmacokinetic principles in therapy of organophosphate poisoning, the administration of obidoxime by an initial bolus dose followed by continuous infusion appears rational. Using this protocol, six patients each with parathion or oxydemeton methyl poisoning were treated. In parathion poisoning, reactivation was possible up to 7 days. At paraoxon concentrations >0.1 mu M obidoxime only partially reactivated acetylcholinesterase (AChE) of erythrocytes in vivo although reactivation could be assessed in vitro, which roughly fitted theoretical calculations. AChE-inhibitory material was detected up to 5 days. Cholinergic signs soon subsided when AChE was above 20% of normal, and atropine plasma levels could be kept below 7 ng/ml. In one patient brain damage persisted. Oxydemeton methyl poisoning responded to obidoxime therapy only when the oxime was instituted shortly after poisoning. Out of six patients one died. No intermediate syndrome and no signs of permanent hepatic dysfunction were found in the 12 patients. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.