Management of acute organophosphorus pesticide poisoning.
Management of acute organophosphorus pesticide poisoning.
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DOI：
10.1016/s0140-6736(07)61202-1
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发表时间：
2008-02-16
期刊：
影响因子：
168.9
通讯作者：
Dawson, Andrew H.
中科院分区：
文献类型：
--
作者：
Eddleston, Michael;Buckley, Nick A.;Eyer, Peter;Dawson, Andrew H.
有机磷农药自身中毒是发展中国家农村地区的一个重要临床问题，估计每年造成20万人死亡。 意外中毒致死的人数要少得多，但在高毒性有机磷农药可用的地方，这是一个问题。医疗管理困难，病死率通常超过15%。我们描述了有限的证据，可以指导治疗和设计进一步的临床研究时应考虑的因素。在首次使用50年后，我们仍然不知道核心治疗药物阿托品、肟类药物和地西泮的最佳给药方式。收集有用数据方面的重要制约因素包括：很晚才认识到各种农药的活性和作用差异很大，以及需要谨慎地进行胆碱酯酶测定，以便使各项研究的结果具有可比性。然而，共识认为，早期复苏与阿托品，氧气，呼吸支持和液体是必要的，以改善氧气输送到组织。肟的作用还不完全清楚;它们可能只对特定农药中毒或中度中毒的患者有益。小型研究表明，硫酸镁等新治疗方法有益，但需要更大规模的试验。洗胃可能有一定的作用，但只有在病人病情稳定后才能进行。亚洲农村地区正在进行随机对照试验，以评估这些疗法的有效性。然而，一些有机磷农药可能很难用目前的疗法治疗，因此禁止使用特定农药可能是大幅降低中毒后病死率的唯一方法。改善对有机磷中毒的医疗管理应能减少全世界自杀死亡人数。
Organophosphorus pesticide self-poisoning is an important clinical problem in rural regions of the developing world, and kills an estimated 200 000 people every year. Unintentional poisoning kills far fewer people but is a problem in places where highly toxic organophosphorus pesticides are available. Medical management is difficult, with case fatality generally more than 15%. We describe the limited evidence that can guide therapy and the factors that should be considered when designing further clinical studies. 50 years after first use, we still do not know how the core treatments—atropine, oximes, and diazepam—should best be given. Important constraints in the collection of useful data have included the late recognition of great variability in activity and action of the individual pesticides, and the care needed cholinesterase assays for results to be comparable between studies. However, consensus suggests that early resuscitation with atropine, oxygen, respiratory support, and fluids is needed to improve oxygen delivery to tissues. The role of oximes is not completely clear; they might benefit only patients poisoned by specific pesticides or patients with moderate poisoning. Small studies suggest benefit from new treatments such as magnesium sulphate, but much larger trials are needed. Gastric lavage could have a role but should only be undertaken once the patient is stable. Randomised controlled trials are underway in rural Asia to assess the effectiveness of these therapies. However, some organophosphorus pesticides might prove very difficult to treat with current therapies, such that bans on particular pesticides could be the only method to substantially reduce the case fatality after poisoning. Improved medical management of organophosphorus poisoning should result in a reduction in worldwide deaths from suicide.