The possible role of intravenous lipid emulsion in the treatment of chemical warfare agent poisoning.
The possible role of intravenous lipid emulsion in the treatment of chemical warfare agent poisoning.
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DOI：
10.1016/j.toxrep.2015.12.007
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发表时间：
2016
影响因子：
--
通讯作者：
Falk A
中科院分区：
文献类型：
--
作者：
Eisenkraft A;Falk A
有机磷（OPs）是胆碱酯酶抑制剂，可导致特征性的应激症状，如分泌过多、瞳孔缩小、呼吸困难、呼吸功能不全、抽搐，如果没有适当和早期的解毒治疗，可导致死亡。这些化合物大多是高度亲脂性的。芥菜是一种有毒的亲脂烷基化剂，通过细胞大分子（如DNA、蛋白质）的烷基化和促炎途径的强烈激活来发挥其损伤作用。目前批准的针对OPs的解毒剂包括外周抗胆碱能药物阿托品和一种能重新激活被抑制的胆碱酯酶的肟。苯二氮卓类药物用于阻止有机磷引起的癫痫发作。尽管有这些核准的药物，但已努力采取其他医疗对策，以减轻接触后的短期和长期临床影响。目前还没有硫磺芥菜中毒的解药。静脉注射脂质乳剂在肠外营养中被用作卡路里的来源。近年来，脂质乳剂在治疗脂溶性化合物中毒的动物模型和人体临床试验中均显示出疗效。在这篇综述中，我们讨论了静脉注射脂质乳剂作为一种辅助治疗化学战剂中毒的有用性。
Organophosphates (OPs) are cholinesterase inhibitors that lead to a characteristic toxidrome of hypersecretion, miosis, dyspnea, respiratory insufficiency, convulsions and, without proper and early antidotal treatment, death. Most of these compounds are highly lipophilic. Sulfur mustard is a toxic lipophilic alkylating agent, exerting its damage through alkylation of cellular macromolecules (e.g., DNA, proteins) and intense activation of pro-inflammatory pathways. Currently approved antidotes against OPs include the peripheral anticholinergic drug atropine and an oxime that reactivates the inhibited cholinesterase. Benzodiazepines are used to stop organophosphate-induced seizures. Despite these approved drugs, efforts have been made to introduce other medical countermeasures in order to attenuate both the short-term and long-term clinical effects following exposure. Currently, there is no antidote against sulfur mustard poisoning. Intravenous lipid emulsions are used as a source of calories in parenteral nutrition. In recent years, efficacy of lipid emulsions has been shown in the treatment of poisoning by fat-soluble compounds in animal models as well as clinically in humans. In this review we discuss the usefulness of intravenous lipid emulsions as an adjunct to the in-hospital treatment of chemical warfare agent poisoning.