Organophosphate Poisoning: 10 Years of Experience in Southern Taiwan

南台灣十年之有機磷中毒病例分析

蔡忠榮(Jong-Rung Tsai) ； 許超群(Chau-Chyun Sheu) ； 鄭孟軒(Meng-Hsuan Cheng) ； 洪仁宇(Jen-Yu Hung) ； 王傳生(Chuan-Sheng Wang) ； 鍾飲文(Inn-Wen Chong) ； 黃明賢(Ming-Shyang Huang) ； 黃吉志(Jhi-Jhu Hwang)

《The Kaohsiung Journal of Medical Sciences》 23卷3期 (2007/03) Pp. 112-119

摘要

有機磷中毒是全世界重要的死因之一，oximes及阿托品是治療有機磷中毒的主要藥物，但是對於有機磷中毒治療方面仍有許多爭議。本篇文章主要針對西元1996年到2005年，本院有機磷中毒患者做回溯性探討，提供有關有機磷中毒治療的經驗及找出其他重要的有機磷中毒的臨床評估指標。此研究共有七十五位有機磷中毒患者，包含50個男性及25個女性患者，死亡率約8%。61個患者是因自殺而導致有機磷中毒，其他則是意外中毒。其中88%的患者出現蕈毒作用，尤其以呼吸道分泌物增加為主要症狀。依據病患臨床嚴重度分成三組：在致命性這組發現有較高的住院天數、感染率及死亡率。起始的血清C反應性蛋白濃度高低和有機磷中毒嚴重程度呈現高度的相關性。約一半的有機磷中毒患者需要加護病房的照顧，21個患者出現呼吸衰竭現象。有機磷中毒會引起血清中的乙醯膽鹼酯脢濃度下降，但是血清中的乙醯膽鹼酯脢濃度下降的程度則和臨床嚴重程度並無相關性。Bardin等人提出有機磷中毒的分級方法可提供臨床醫師早期去評估患者及針對致命性的有機磷中毒患者安排加護病房照護。起始的血清C反應性蛋白濃度則提供另一種臨床嚴重度的評估。雖然有機磷中毒的處理主要是以支持性療法及抗乙醯膽鹼作用為主，但是在中毒後的72小時內臨床醫師必須特別注意呼吸衰竭發生的可能性。

關鍵字

乙醯膽鹼酯脢 ； C反應性蛋白 ； 有機磷中毒

並列摘要

Poisoning due to organophosphate pesticides is an important cause of morbidity and mortality worldwide. Although standard treatments involving the administration of atropine and oximes have been used, there remain many controversial areas concerning organophosphate poisoning (OPP). Herein, we present our 10 years of experience in assessing the severity of OPP in southern Taiwan. A retrospective study was performed on patients admitted with OPP. A total of 75 patients (50 males and 25 females) were studied between January 1996 and December 2005. Diagnosis was based on a clinical assessment and serum acetylcholinesterase (AChE) level at the time of hospital admission. The severity of OPP was assessed using the grading system of Bardin et al. The duration and dosage of atropine and palidroxime were recorded. All the biochemical data were analyzed. Sixty-one of the patients had attempted suicide and 14 patients had accidental exposure. The overall mortality rate was 8%. Muscarinic effects were observed in 66 (88%) of the OPP patients and the most frequent symptom was bronchial hypersecretion (52%). Among these three different severity groups, prolonged length of stay, higher infection rates, and higher mortality were found in the life- threatened group. The initial serum C-reactive protein (CRP) level was strongly correlated to the severity grading of the OPP. Nearly half of the patients were admitted to the intensive care unit (ICU) and, of this, 21 patients developed respiratory failure within 72 hours. Low serum AChE levels support the diagnosis of OPP, but no significant association was found between the severity of OPP and serum AChE levels. The grading system of Bardin et al is very helpful for physicians to facilitate the recognition of seriously poisoned subjects, and to permit their early admission to an ICU. Initial serum CRP, an acute phase reactant, had significant value in assessing the severity of the OPP. Although the management of acute OPP is supportive and the recovery rate is high, anti-cholinergic therapy should be used as soon as possible to counteract muscarinic effects. Physicians must be aware of the potential dangers of respiratory failure, which could occur within 72 hours of OPP.

並列關鍵字

acetylcholinesterase ； C-reactive protein ； organophosphate poisoning