Treatment of organophosphate poisoning. Experience of nerve agents and acute pesticide poisoning on the effects of oximes
Treatment of organophosphate poisoning. Experience of nerve agents and acute pesticide poisoning on the effects of oximes
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DOI：
10.1016/s0928-4257(99)80008-4
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发表时间：
1998-10-01
影响因子：
--
通讯作者：
Shariat, M
中科院分区：
文献类型：
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作者：
Balali-Mood, M;Shariat, M
有机磷化合物已被用作杀虫剂和化学战（神经毒剂）。伊拉克军队对伊朗军队和无辜人民使用了两种神经毒剂，塔本和沙林。数百名暴露在外的战士战死在战场上。大剂量硫酸阿托品已被成功地用于抵消OP中毒的毒蕈碱效应。氧肟对人体OP中毒的影响尚未得到很好的研究。目的是研究奥比多肟和普拉西多肟在OP农药中毒中的作用。将患者分为阿托品(A)组、奥比多肟+阿托品（OA）组和普拉多肟+阿托品（PA）组。63例患者（男33例，女30例），平均年龄25岁，分为a组43例，OA组22例，PA组8例。两组患者入院时主要临床表现及乙酰胆碱酯酶（AChE）活性差异无统计学意义。治疗期间观察到显著的变化。尽管中毒的严重程度——尤其是呼吸系统并发症在OA组和PA组中更为明显——但PA组中没有死亡病例，而A组和OA组分别有4例（9%）和6例（50%）患者死亡。AChE再激活仅在PA组出现，但无统计学意义（r = 0.4747）。乙酰胆碱酯酶再激活与患者预后有良好的关系。高剂量的奥比肟（8mg /kg，随后是2mg /kg/h）被发现有肝毒性，应避免使用。高剂量的哌拉西肟（30 mg/kg和8 mg/kg/h）没有引起严重的副作用，可能对某些有机磷农药中毒有效。（(C) Elsevier，巴黎）。
Organophosphate (OP) compounds have been used as pesticides and in chemical warfare (nerve agents). Two nerve agents, tabun and sarine, were used by the Iraqi army against Iranian troops and innocent people. Hundreds of the exposed combatants died in the field. Atropine sulphate has been used successfully in large doses to counteract the muscarinic effects of OP poisoning. The effects of oximes in human OP poisoning have not been well studied. Our aim was to study the effects of obidoxime and pralidoxime in OP pesticide poisoning. The patients were divided into three groups: atropine (A), obidoxime + atropine (OA) and pralidoxime + atropine (PA). Sixty-three patients (33 males, 30 females) with a mean age of 25 years were studied in different groups (43 A, 22 OA and 8 PA). There were no statistical significant differences in major clinical findings and acetylcholinesterase (AChE) activity on admission between the groups. Significant changes were observed during the treatment. Notwithstanding the severity of intoxication - particularly respiratory complications were more observed in the OA and PA groups - there were no fatalities in the PA group, whereas 4 (9%) and 6 (50%) patients in the A and OA groups died, respectively. AChE reactivation was only observed in the PA group, although it was not statistically significant (r = 0.4747). There was a good relationship between the AChE reactivation and outcome of the patients. High doses of obidoxime (8 mg/kg followed by 2 mg/kg/h) were found to be hepatotoxic and should be avoided. High doses of pralidoxime (30 mg/kg followed by 8 mg/kg/h) did not induce serious side effects and may be effective in some OP pesticides poisoning. ((C) Elsevier, Paris).