Oximes in acute organophosphorus pesticide poisoning: a systematic review of clinical trials.
Oximes in acute organophosphorus pesticide poisoning: a systematic review of clinical trials.
复制标题
DOI：
10.1093/qjmed/95.5.275
复制
发表时间：
2002-05
影响因子：
13.3
通讯作者：
Buckley, N
中科院分区：
文献类型：
--
作者：
Eddleston, M;Szinicz, L;Eyer, P;Buckley, N
在发展中国家，急性有机磷（OP）农药中毒每年导致数万人死亡。标准治疗包括静脉注射阿托品和肟来对抗突触的乙酰胆碱酯酶抑制。然而，在过去的20年里，世界上许多地方的医生对哌拉西肟和奥比肟等肟类药物的有效性提出了质疑，因为他们未能在临床实践中看到益处。我们进行了一项系统综述，以发现OP中毒中肟的随机对照试验（rct）。已发表的两项随机对照试验涉及182名接受哌拉西肟治疗的患者。随机对照试验没有发现哌拉西肟的益处，并被用来论证哌拉西肟不应用于OP中毒。这些医生在困难的环境中尝试重要的研究，必须受到祝贺。然而，这些研究没有考虑到最近澄清的对结果很重要的问题，发表的方法也不清楚，因此，这种概括性的陈述不能得到发表的结果的支持。有很多原因可以解释为什么氧肟可能与热带地区典型的压倒性自我中毒无关。然而，我们认为需要一个大型的随机对照试验来比较目前世界卫生组织推荐的普拉多肟方案（>30mg/kg，然后>8mg/kg/hr输注）和安慰剂，以明确确定肟治疗在OP自我中毒中的作用。这样的研究将需要设计预先定义的亚组分析，以便确定可能受益于肟的患者亚组。
Acute organophosphate (OP) pesticide poisoning causes tens of thousands of deaths each year across the developing world. Standard treatment involves the administration of intravenous atropine and oxime to counter acetylcholinesterase inhibition at the synapse. The usefulness of oximes, such as pralidoxime and obidoxime, has however been challenged over the past 20 years by physicians in many parts of the world who have failed to see benefit in their clinical practice. We have carried out a systematic review to find randomised controlled trials (RCTs) of oximes in OP poisoning. Two RCTs have been published involving 182 patients treated with pralidoxime. The RCTs did not find benefit with pralidoxime and have been used to argue that pralidoxime should not be used in OP poisoning. These physicians must be congratulated for attempting important studies in a difficult environment. However, the studies did not take into account recently clarified issues important for outcome and the published methodology is unclear, therefore such a generalised statement cannot be supported by the published results. There are many reasons why oximes may not be relevant in the overwhelming self-poisoning typical of the tropics. However, we believe that a large RCT is required to compare the current WHO-recommended pralidoxime regimen (>30mg/kg bolus followed by >8mg/kg/hr infusion) with placebo to determine definitively the role of oxime therapy in OP self-poisoning. Such a study will need to be designed with pre-defined subgroup analysis to allow the identification of patient subgroups that may benefit from oximes.