透過您的圖書館登入
IP:44.200.23.133
  • 期刊

有機磷中毒所引發的遲發性神經病變:個案報告

Delayed Neuropathy Due to Organophosphate Intoxication: A Case Report

摘要


有機磷中毒會使乙醯膽鹼酶(acetylcholinesterase)不活化,進而造成乙醯膽鹼堆積,使得乙醯蟾鹼接受器受到過度刺激,在急性期會產生流涎、大小便失禁、嘔吐、肌肉無力、高血壓、心悸、燥動、頭痛、嗜睡、意識不清、抽搐等症狀。患者經適當治療後會自急性中毒中復元,但嚴重者會留下神經學後遺症,包括中樞及周邊神經病變。輕者可於數月後復原,重者則會終生留有後遺症。 個案是二十歲女性,於1995年喝有機磷農藥(美蘭丹80cc)企圖自殺,在急性期過後產生遲發性神經病變,臨床症狀為雙下肢無力,不良於行。在本院所做的神經傳導與肌電圖檢查顯示下肢運動神經為主的多發性神經病變及中樞神經病變,追蹤八年經數次的神經學檢查發現複合肌肉電位波(CMAP)之振幅及神經傳導速度均有明顯改善,但仍未達正常值。個案曾於本院及其他院所接受復健治療,包括雙下肢肌肉電刺激、關節運動、拉筋運動、肌力訓練、水中運動、行走訓練、日常生活功能訓練及雙側垂足板的使用。治療後功能有明顯改善。目前個案雙下肢仍有痙攣及不自主抽動現象,下肢肌力使用徒手肌力測試為0-3。此外,雙側踝關節亦有攣縮現象。上肢及下肢感覺功能均屬正常。個案目前可拿雙側腋下拐杖行走,日常生活完全獨立,且能從事全職工作。

並列摘要


Organophosphates (OP) are inhibitors of acetylcholinesterase. OP intoxication results in an accumulation of acetylcholine. Clinical signs and symptoms of acute OP poisoning include salivation, incontinence, vomiting, muscle weakness, hypertension, palpitation, restlessness, headache, drowsiness, confusion and seizure. After the acute stage of OP intoxication some patients recover fully, but others have neurologic sequelae, including central and peripheral neuropathy. Individuals with milder cases may recover fully within several months; however, more severe cases may result in persistent sequelae. A 20-year old woman attempted suicide by drinking organophosphate pesticide in 1995. Although emergency and acute medical treatments saved her life, she developed delayed neuropathy, with bilateral weakness in the lower extremities. She was unable to walk and needed a wheelchair for daily transfers. Nerve conduction studies and needle electromyographic examination revealed peripheral neuropathy, with greater involvement of the motor nerves of the lower extremities, and central neuropathy. After an 8-year follow-up, nerve conduction studies showed improvement in amplitude and nerve conduction velocities of the compound muscle action potential, but did not reach normal range. After rehabilitative therapies including: electrical stimulation, range of motion exercise, stretching exercise, muscle strengthening exercise, aquatic exercise, ambulation training with bilateral ankle-foot-orthosis, and activities of daily living (ADL) training, functional improvement was obvious. The patient can now ambulate independently with bilateral axillary crutches. ADL5 are totally independent as well. At this time, the woman we followed has a positive life, with a supportive family, and is gainfully employed.

延伸閱讀