Intermediate Syndrome after Organophosphate Ingestion

有機磷中毒個案並不少見，然而有機磷中毒引起的中間症候群於台灣並無報告案例。本病例報告為一位賽達松中毒病患，於急性膽鹼症狀緩解後，突發呼吸衰竭，為一遲緩發作之中間症候群個案。根據電生理研究之文獻，目前認為中間症候群的發生，乃由於有機磷長時間抑制乙醯膽酯酶之功能，造成過多乙醯膽鹼堆積於神經肌肉交界處，進而使乙醯膽鹼受體功能下降。然而現今並無準確的方法可以預測中間症候群的發生，也許電生理檢查可以應用；治療上除了呼吸器支持外，oxime類藥物之實證地位尚未確切建立。因此，中間症候群之診治對於急重症醫師來說，仍為一大挑戰。臨床醫師照顧有機磷中毒病患時，千萬不可輕忽此可能致死的併發症。

關鍵字

中間症候群；有機磷中毒；賽達松

並列摘要

Organophosphate poisoning is not uncommon in Taiwan. However, no case of intermediate syndrome (IMS) has been published. We report a case of delayed-onset IMS presenting with abrupt respiratory failure following the acute cholinergic crisis of phenthoate poisoning. Based on electrophysiological studies from the literature, IMS results from an excess amount of acetylcholine at neuromuscular junction nicotinic acetylcholine receptors due to prolonged inhibition of acetylcholinesterase. This phenomenon leads to downregulation of the acetylcholine receptor and promotes muscle weakness. There are still no appropriate parameters to predict the development of IMS. Perhaps electrophysiological studies can be applied in the future. Ventilatory support is the most important treatment; the benefits of pralidoxime treatment are still controversial. IMS is still a challenging complication of organophosphate poisoning. Physicians should not overlook IMS.

並列關鍵字

Intermediate syndrome ； Organophosphate poisoning ； Phenthoate

國際替代計量

Intermediate Syndrome after Organophosphate Ingestion

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