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Background The current treatment program with penehyclidine hydrochloride (PHC) for acute severe organophosphorus pesticide poisoning (ASOPP) patients exerts a positive effect but with concerned adverse reactions. Objective To evaluate the treatment effect of a revised ASOPP treatment program with PHC. Methods A prospective single-blind randomized controlled trial was conducted. A total of 157 patients with ASOPP were divided into a revised treatment group (82 cases) and a conventional treatment group (75 cases) by random number table. The two groups received the same basic treatment measures including active life support, routine gastric lavage, catharsis, and pralidoxime treatment. The revised treatment group followed a revised PHC treatment protocol initiated by first a small dose of PHC and followed by small doses of PHC administration/discontinuation through frequent observations at different time points. The conventional treatment group received the conventional program. Treatment effects and incidence rates of possible adverse reactions were compared between the two groups. Results Compared with the conventional treatment group, the revised treatment group obtained delay in penetrogenation time point, higher success rate in catharsis, earlier cholinesterase-turning time, and shorter hospitalization period with statistical significance (all Ps＜0.05). No differences were found in terms of time for symptoms of poisoning to disappear, incidence rates of intermediate myasthenic syndrome and delayed polyneuropathy, mechanical ventilation time, and cure rate (all Ps＞0.05). Less adverse reactions occurred in the revised treatment group including tachycardia and delirium than in the conventional treatment control group (all Ps＜0.05). Conclusion The revised ASOPP treatment program with PHC is similar to the current recommended treatment program in treatment effects, but with less adverse reactions.
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BACKGROUND@#Penehyclidine is a newly developed anticholinergic agent. We aimed to investigate the role of penehyclidine in acute organophosphorus pesticide poisoning (OP) patients.@*METHODS@#We searched the Pubmed, Cochrane library, EMBASE, Chinese National Knowledge Infrastructure (CNKI), Chinese Biomedical literature (CBM) and Wanfang databases. Randomized controlled trials (RCTs) recruiting acute OP patients were identified for meta-analysis. Main outcomesincluded cure rate, mortality rate, time to atropinization, time to 60% normal acetylcholinesterase (AchE) level, rate of intermediate syndrome (IMS) and rate of adverse drug reactions (ADR).@*RESULTS@#Sixteen RCTs involving 1,334 patients were identified. Compared with the atropine-or penehyclidine-alone groups, atropine combined with penehyclidine significantly increased the cure rate (penehyclidine+atropine vs. atropine, 0.97 vs. 0.86, RR 1.13, 95% CI [1.07–1.19]; penehyclidine+atropine vs. penehyclidine, 0.93 vs. 0.80, RR 1.08, 95% CI [1.01–1.15]) and reduced the mortality rate (penehyclidine+atropine vs. atropine, 0.015 vs. 0.11, RR 0.17, 95% CI [0.06–0.49]; penehyclidine+atropine vs. penehyclidine, 0.13 vs. 0.08, RR 0.23, 95% CI [0.04–1.28]). Atropine combined with penehyclidine in OP patients also helped reduce the time to atropinization and AchE recovery, the rate of IMS and the rate of ADR. Compared with a single dose of atropine, a single dose of penehyclidine also significantly elevated the cure rate, reduced times to atropinization, AchE recovery, and rate of IMS.@*CONCLUSION@#Atropine combined with penehyclidine benefits OP patients by enhancing the cure rate, mortality rate, time to atropinization, AchE recovery, IMS rate, total ADR and duration of hospitalization. Penehyclidine combined with atropine is likely a better initial therapy for OP patients than atropine alone.
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Objective To improve the prognosis among patients with respiratory failure poisoned by organophosphorus pesticide though analyzing and discussing the emergency measures and treatment effects. Methods From January 2014 to December 2016, 86 patients with respiratory failure caused by severe organophosphorus pesticide poisoning were received in the Emergency Department in Nanchong Central Hospital.The patients were numbered according to the order of the treatment and randomly divided into control group and observation group with 43 cases in each group.All patients were treated with routine emergency measures (gastric lavage and endotracheal intubation, rehydration, and symptomatic treatment).The control group was treated with pralidoxime chloride injection and injection of atropine detoxification while the observation group was given pralidoxime chloride combined with Penehyclidine Hydrochloride Injection detoxification.We compared the alleviation of clinical symptoms and the changes of cholinesterase (CHE) and respiratory function (respiratory frequency, Pa02, Pa02/Fi02) between the two groups of patients 10 min and 30 min after administration. The statistics of atropinization time, blood purification treatment rate, tracheotomy rate, hospital mortality,complications and treatment time were recorded. Results No statistic significance was observed among the two groups of patients in gender,age, weight,body mass index (BMI),the severity of poisoning,types of organophosphorus drugs and blood cholinesterase (CHE) at the first visit (P＞0.05).Blood CHE was effectively improved among the two groups 10 min and 30 min after the treatment and significantly higher CHE was seen in the observation group compared to the control group (P＜0.05) . The overall clinical symptom rate was lower 10min and 30min after the treatment (P＜ 0.05), and the clinical symptom rate of the observation group was lower than that of the control group (P＜0.05) . The respiratory function indexes (respiratory rate, Pa02, Pa02/Fi02) were significantly improved 10 min and 30 min after the treatment in both groups compared with those before the treatment (P＜ 0.05) .The blood purification treatment rate, tracheotomy rate, complication rate, hospitalization time and atropine time of the observation group were significantly lower than those of the control group (P＜ 0.05) . No significant difference was found in mortality rate between the two groups (P＞0.05).Conclusion After giving effective respiration and circulation support, administration of penehyclidine hydrochloride combined with pralidoxime chloride detoxification can effectively restore the cholinesterase activity among patients with organophosphorus pesticide poisoning and improve respiratory function and prognosis, whichshows a high clinical value.
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Objective To explore the effect of single blood perfusion combined with blood perfusion combined with continuous venous venous blood filtration (sequential blood purification) on myocardial injury in patients with severe acute organophosphorus pesticide poisoning.MethodsRetrospectively analyzed in July 2013 to July 2015 treated in our hospital see a doctor and a total of 94 patients with severe acute organophosphorus pesticide poisoning, depending on the patient's blood purification scheme, divided the patients into blood perfusion group (n=48) and sequential blood purification group (n=46), contrast after treatment on two groups of clinical curative effect, the condition of myocardial spectrum index and its complications.ResultsAfter treatment, blood perfusion group of left ventricular ejection fraction was (53.8±5.8)%, sequential left ventricular ejection fraction after blood purification treatment group was (58.1±3.4)%, both have obvious difference, has statistics meaning (P<0.05).In terms of myocardial enzyme spectrum index, and sequential blood purification group is obviously better than the index of myocardial enzymes in patients with blood perfusion group (P<0.05).The incidence of complications in patients with sequential blood purification group were lower than the blood perfusion group (P<0.05).ConclusionThe joint continuity venous blood perfusion-blood purification scheme of vein hemofiltration treatment of patients with severe acute organophosphorus pesticide poisoning can significantly improve treatment effect.
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Objective To compare the clinical effect of penehyclidine hydrochloride and atropine in the treatment of acute organophosphorus pesticide poisoning.Methods 86 patients with organophosphorus pesticide poisoning were selected and randomly assigned to the observation group and the control group according to the digital table,43 cases in each group.The two groups were given conventional treatment,while the control group was treated with atropine,the observation group was given penehyclidine hydrochloride.The disappearance time of main symptoms, rescue success rate and adverse reactions of the two groups were observed.Results After salvage treatment, the rescue success rate of the observation group was 97.8%,which of the control group was 88.4%,the difference was statistically significant (x2=1.433,P<0.05).The disappear time of M like symptoms,N like symptoms and central nervous system symptoms in the observation group was significantly shorter compared with the control group (all P<0.05).The number of drugs,dosage,cholinesterase recovery time and hospitalization time between the two groups had statistically significant differences (P<0.05).The incidence rates of blurred vision,restlessness,heart rate and urinary retention in the control group were significantly higher than those in the observation group (all P<0.05).Conclusion Penehyclidine hydrochloride for acute organophosphorus pesticide poisoning can significantly reduce the incidence of symptoms,shorten the disappearance time of symptoms,reduce hospitalization time,improve the efficacy of rescue,reduce the incidence of adverse reactions, it is safe,effective and has great clinical significance.
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Objective To investigate the effects of penehyclidine hydrochloride injection combined with safflower injection on TLRs/NF-κB signaling pathway and T cell subsets in mononuclear cells of patients with organophosphorus pesticide poisoning. Methods 80 cases of organophosphate poisoning patients from June 2014 to June 2016 in onglu first people's hospital were selected,randomly divided into control group and observation group, the control group was treated with penehyclidine hydrochloride,observation group were treated with Honghua injection based on the treatment of control group. The effects were compared between two groups of TLRs/NF-κB in peripheral blood mononuclear cells pathway and T cell subsets in peripheral blood, and compared two groups of patients with cholinesterase activity. Results On the third,fifth and 7th day of treatment,cholinesterase activity in both groups was higher than that before treatment,the activity of cholinesterase in the observation group was significantly higher than that in the control group (P<0.05).After treatment,compared with before treatment,the levels of TLR2,TLR4 and NF-κB in the two groups were significantly decreased,and TLR2,TLR4,NF-κB levels in the observation group were lower than those in the control group, the difference was statistically significant (P<0.05),Th17,Th17/Treg levels in the observation group were significantly lower,and lower than the control group,Treg content was significantly higher,and higher than the control group,the difference was statistically significant (P<0.05). Conclusion Penehyclidine hydrochloride injection combined with safflower injection can help to reduce Th17,Th17/Treg levels,increased Treg cell content,regulate the inflammatory response, and promote recovery of cholinesterase activity.
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Objective To investigate the effect of different doses of pralidoxime chloride on clinical outcome including recovery rate and mortality in patients with acute organophosphorus pesticide poisoning.Methods According to the total amount of pralidoxime chloride administered over the first 24 hours or entire duration of hospitalization,a cohort of 163 organophosphorus pesticide poisoning patients,admitted from February 2004 to December 2014 were assigned to different groups followed by a retrospective analysis.Comparisons of recovery rate,mortality rate,mean length of hospital stay,and duration of mechanical ventilation were made among groups.SPSS 18.0 was used to analyze categorical variables between the data of groups with x2 test/Fisher exact probability method and numerical variables with t test or One-way ANOVA,and statistical significance was set as P ＜ 0.05.Results According to the amount of pralidoxime chloride given over the first 24 hours,the recovery rate and the mortality rate were significantly improved in the experimental group (pralidoxime chloride ＞ 2 g) than in the control group (pralidoxime chloride ＜ 2 g) (P =0.04).There was no significant difference in mean length of hospital stay between the experimental group and the control group (P =0.171),and there were statistically significant differences in recovery rate and mortality rate among the four dose-response subgroups (total dosage administered in 24 hours in group A ＜ 1 g,in group B ＜2 g,in group C ＜4 g and in group D ＞4 g) (P =0.034).Based on the total amount of pralidoxime chloride prescribed in the entire duration of hospital stay,the recovery rate and mortality rate were significantly better in the experimental group than those in control group (P =0.002),and among the three dose-response subgroups,the significant difference in recovery rate and mortality rate were also observed (P =0.006).Conclusions Increased amounts of pralidoxime chloride prescribed in the first 24 hours and in the whole hospitalized period can improve the recovery rate and reduce the mortality rate in organophosphorus pesticide poisoning patients.
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Objective To study the clinical effect of sequential therapy by intravenous fat emulsion and hemoperfusion in patients with severe organophosphorus pesticide poisoning. Methods Seventy-two patients with severe organophosphorus pesticide poisoning were selected, and the patients were divided into sequential therapy group (36 cases) and conventional therapy group (36 cases) by random digits table method. All the patients were given conventional therapy including gastrolavage, purgation, fluid infusion, atropine, pralidoxime chloride, anti- infection, breath support and hemoperfusion. The patients in sequential therapy group were given intravenous fat emulsion before hemoperfusion. The clinical effect was compared between 2 groups. Results There were no statistical differences in the serum cholinesterase activity on admission and in the first day after treatment between 2 groups (P>0.05). The serum cholinesterase activities in the second, third and seventh day after treatment in sequential therapy group were significantly higher than those in conventional therapy group: (456.3 ± 45.6) U/L vs. (391.3 ± 39.8) U/L, (862.3 ± 96.2) U/L vs. (614.7 ± 78.5) U/L and (1950.9 ± 366.7) U/L vs. (1543.6 ± 285.9) U/L, and there were statistical differences (P<0.05). The total doses of atropine applied and length of stay in sequential therapy group were significantly less than those in conventional therapy group: (85.4 ± 36.2) mg vs. (104.7 ± 45.3) mg and (10.5 ± 4.2) d vs. (13.6 ± 6.2) d, and there were statistical differences (P<0.05). The recovery rate in sequential therapy group was significantly higher than that in conventional therapy group:97.2%(36/36) vs. 80.6%(29/36), and there was statistical difference (P<0.05). Conclusions Sequential therapy by intravenous fat emulsion and hemoperfusion can improve the serum cholinesterase activity, and decrease the total dose of atropine in patients with severe organophosphate pesticide poisoning.
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Objective To investigate the clinical effect of shuxuening treatment on organophosphorus pesti-cide poisoning with toxic myocarditis.Methods 60 patients with organophosphorus toxic myocarditis were selected in our hospital as the research subjects,and 60 cases were divided into two groups:observation group(n =30) and control group(n =30).Control group was given conventional treatment,treatment group was given shuxuening injec-tion 14 days on the basis of conventional treatment.After treatment,creatine kinase isoenzyme (CKMB),troponin (TNI),interleukin 6 (IL -6) and cholinesterase(ChE) were compared,and the changes of clinical symptoms were observed at the same time.Results There was no significant difference between the observation group and the control group(χ2 =0.630,P =0.730).The TNI,IL -6,CKMB could reflect the severity of myocardial injury in patients with different degrees of organic phosphorus poisoning,TNI,CK -MB,IL -6 increased with the degree of poisoning,the differences were statistically significant(F =11.863,4.512,3.774;P =0.000,0.015,0.029).After treatment for 4, 9,14 days,TnI,CK,CK -MB,levels of IL -6 in the two groups were recovered,but the recovery levels of TnI,CK -MB and IL -6 of the observation group significantly better than the control group,the differences were statistically sig-nificant(Fourth days,t =8.125,5.128,10.461;P =0.000,0.001,0.000;Ninth days,t =5.464,4.674,9.510;P =0.001,0.002,0.000,t =6.162,8.248,5.523;P =0.000,0.000,0.001).Conclusion Conventional treatment combined with shuxuening in the treatment of organophosphorus pesticide poisoning with toxic myocarditis has better therapeutic effect,it is worthy of promotion.
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Objective To investigate the effect and safety of transcutaneous electrical stimulation at Zusanli acupoint for elimination of gastrointestinal poison in patients with oral organophosphorus pesticide poisoning. Methods A prospective study was conducted, including 62 patients with oral organophosphorus pesticide poisoning from September 2013 to February 2015 in the Department of Emergency of Xingtai People's Hospital of Hebei Province. The patients were divided into a observation group and a control group (each, 31 cases) in accord with the principle of simple random sampling. All the patients in two groups were given comprehensive treatment according to the diagnosis and treatment of the guide for organic phosphorus pesticide poisoning. In addition, the transcutaneous electrical stimulation at bilateral Zusanli acupoints was carried out in the observation group, once therapeutic time 30 minutes and every 8 hours once, and stopped until the discharge of melena. The incidence of vomiting after application of cathartics, the first stool time, the time of melena discharge, daily defecation frequency, the time of reaching atropinization, the total amount of atropine used, the time of cholinesterase (ChE) activity returning to its 1/2 normal activity, the length of stay in hospital, cure rate and mortality were observed in both groups. The changes in hemodynamics and pulse blood oxygen saturation (SpO2) were observed before and after transcutaneous electrical acupoint stimulation, and the occurrence of adverse reactions in the therapeutic course were observed in the observation group.Results After application of cathartics, the incidence of vomiting in control group was significantly higher than that in the observation group [32.2% (10/31) vs. 9.7% (3/31),P < 0.05]. In the observation group, the first stool time (hours: 9.3±3.6 vs. 11.6±5.2) and the time of melena discharge (hours: 11.3±5.3 vs. 14.5±6.8) were significantly shorter than those in the control group (both P < 0.05); while the frequency of bowel movements during catharsis was higher than that of the control group (times/d: 4.3±0.5 vs. 3.1±0.4,P < 0.01). In the observation group, the time reaching atropinization (hours: 66.3±22.8 vs. 84.6±24.2), the total amount of atropine used (mg: 66.3±22.8 vs. 84.6±24.2), and the time of ChE activity returning to its 1/2 normal range (days: 6.1±2.4 vs. 8.3±3.9) were significantly shorter than those in the control group (allP < 0.01). At the end of treatment, the average length of stay in hospital was shorter (days: 11.3±2.8 vs. 13.4±4.2,P < 0.05) and the cure rate was higher [96.8% (30/31) vs. 83.9% (26/31),P < 0.05] in the observation group than those in the control group; in observation group, the hemodynamics and SpO2 before and after acupoint electrical stimulation did not change significantly; in the course of treatment, no adverse reactions occurred.Conclusion The addition of transcutaneous electric stimulation at bilateral Zusanli acupoints in patients with oral organophosphorus pesticide poisoning has following advantages: lowering the incidence of vomiting during catharsis, enhancing the cathartic effect, promoting gastrointestinal poisoning discharge as soon as possible, reducing total atropine used during hospitalization, shortening the time reaching atropinization, shortening the duration of hospitalization, promoting the recovery of cholinesterase activity and elevating clinical therapeutic effects.
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Objective To investigate the clinical effect of rhubarb combined with smecta in the treatment of acute organophosphorus pesticide poisoning (AOPP).Methods Seventy-six patients with severe AOPP admitted in the Emergency Centre of Heze Municiple Hospital in Shandong Province from June 2011 to June 2014 were enrolled in this study. They were divided into observation group and control group by the random number table method, 38 cases in each group. The comprehensive routine treatment of gastric lavage to thoroughly clear the gastric content, appropriate application of penehyclidine and atropine for detoxication, pralidoxime chloride, etc. were given to the two groups. On the basis of the above conventional treatment, the observation group was treated with rhubarb 30 g for catharsis and smecta 30 g for adsorption once in every 4 hours, two drugs applied alternately for 48 hours, while the control group was treated with 33% magnesium sulfate 60 mL for catharsis and bleaching clay 200 g for adsorption once in every 4 hours, two drugs applied alternately for 48 hours. The treatment effect, dosage, incidence of complication and case fatality rate in both groups were observed.Results The first defecation time (hours: 5.8±3.7 vs. 9.4±4.6), gastrointestinal function recovery time (hours: 21.7±6.1 vs. 25.2±8.3), atropinization time (minutes: 51.8±23.9 vs. 68.5±20.1), conscious recovery time (days: 2.3±1.2 vs. 3.6±1.9), the time of cholinesterase (ChE) activity returning to more than 50% (days: 4.7±2.3 vs. 6.1±2.9) and the length of stay in hospital (days: 9.2±4.9 vs. 12.3±6.9) were obviously shorter in the observation group than those of the control group (P < 0.05 orP < 0.01); the used dosage of atropine (mg: 234.3±37.1 vs. 265.7±31.4) and penehyclidine (mg: 19.2±14.3 vs. 36.7±25.4) and the incidence of adverse reactions of poisoning rebound [7.9% (3/38) vs. 31.6% (12/38)], intermediate syndrome [2.6% (1/38) vs. 18.4% (7/38)], delayed neuropathy [0 (0/38) vs. 15.8% (6/38)] in the observation group were significantly lower than those of the control group (P < 0.05 orP < 0.01). No death occurred in both groups.Conclusion At present, the combination of smecta and rhubarb is a relatively good method of catharsis and adsorption to completely clear the gastrointestinal toxic residues inside the patients with AOPP, and it can reduce the amount of drugs used, the incidence of complications and the duration of hospital stay.
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Objective To observe the clinical curative effect of Depmas double blood purification system for acute severe organophosphorus pesticide poisoning.Methods Retrospectively study was carried out on 147 patients of acute severe organophosphorus pesticide poisoning.Patients were divided into four groups,the conventional treatment group treated with drug therapy,hemoperfusion group given HA230 hemoperfusion in addition to conventional treatment,plasma exchange combined with hemoperfusion group given HA230 hemoperfusion and plasma exchange therapy in addition to conventional treatment,and Depmas group treated with plasma separation by Baxter blood fiber and then given series HA230 and BS330 hemoperfusion treatment on the separated plasma in addition to conventional treatment.Survival rate,mean survival time of death patients,the concentration changes of cholinesterase and bilirubin in peripheral blood were observed.Results Compared to the conventional treatment group,survival rates of hemoperfusion group,hemoperfusion combined with plasma exchange group and Depmas group were higher,the mean survival time was longer,the cholinesterase concentration in peripheral blood was higher and the elevated bilirubin concentration was decreased with the differences statistically significant (P＜0.01).Compared to hemoperfusion group,the survival rates of hemoperfusion combined with plasma exchange group and Depmas group were higher,the mean survival time was longer,the cholinesterase concentration in peripheral blood were higher and the elevated bilirubin concentration was decreased with the differences statistically significant (P＜0.05).Besides,there were no significant differences between the survival rate,mean survival time,peripheral blood cholinesterase and bilirubin concentration of hemoperfusion combined with plasma exchange group and that of Depmas group (P＞0.05).Conclusions Depmas dual blood purification system has remarkable curative effect for the treatment of acute severe organophosphorus poisoning.
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Objective To investigate the clinical value of copeptin and ischemia modified albumin combined determination in the early diagnosis and clinical significance in myocardial damage of acute organic phosphorus pesticide poisoning .Methods Eighty‐six cases of AOPP patients were divided into two groups :the myocardial injury group (50 cases) and non myocardial injury group (36 cases) ;30 healthy people were selected as the control group .3 mL of venous blood were collected for all subjects involved within one hour in admission ,and their cTnI ,IMA and copeptin levels were detected .Results Compared with the control group ,the copep‐tin levels of non myocardial injury group and myocardial injury group were elevated and there was significant difference (P< 0 .05) ;the difference between myocardial injury group and non myocardial injury groups was also significantly different (P< 0 .05) .Among them ,the comparison between severe and mild to moderate group revealed that the IMA and copeptin levels reduced obviously ,there was significant difference (P< 0 .05) ;in myocardial injury group ,the IMA and copeptin levels of patients in different poisoning de‐gree were negatively correlated .Conclusion Early determination of IMA and copeptin level has important significance in the early diagnosis of myocardial injury in patients with poisoning in AOPP ,and could provide guidance for clinical medication .
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Objective To investigate the extubated timing in acute severe organophosphorus pesticide poisoning patients.Methods Seventy-five patients with mechanical ventilation for acute severe organophosphorus pesticide poisoning were divided into early group (34 cases) and late group (41 cases) by extubation time.Mechanical ventilation time,ICU retention time,tracheal intubation time,ventilator-associated pneumonia (VAP) incidence and extubation success rate of both groups were observed.Results The mechanical ventilation time,ICU retention time between two groups showed no significant difference [(110.66±28.59)h vs.(114.47±34.21)h,(140.63±28.52)h vs.(138.44±34.74) h,P＞0.05].The tracheal intubation time in late group was significantly longer than that in early group [(135.27 ± 28.84) h vs.(119.03 ± 35.05) h,P ＜ 0.05],but the VAP incidence was nostatistically significant difference between two groups [29.27％ (12/41) vs.20.59％ (7/34),P ＞ 0.05].The success rate of extubation in late group was significantly higher than that in early group [97.56％ (40/41) vs.79.41％ (27/34),P ＜ 0.05].Conclusion Delayed extubation can significantly improve the chances of successful extubation,and no increase in VAP risk and more secure in acute severe organophosphorus pesticide poisoning patients.
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Objective To explore the variation and clinical significance of serum cardiac troponin I (cTnI) and interleukin-6 (IL-6) in patients with acute organophosphorus pesticide poisoning (AOPP).Methods The serum cTnI and IL-6 levels in 97 patients with AOPP(AOPP group) and 40 healthy subjects (control group) were tested by double antibody sandwich enzyme linked immunosorbent assay and compared between two groups.Results The serum cTnI and IL-6 levels in AOPP group on admission,admission 1,3 d were respectively (2.51 ± 0.80),(2.11 ± 0.67 ),( 1.58 ± 0.50) μ g/L and ( 154.82 ± 49.15 ),( 139.33 ± 44.23),(108.37 ± 34.40) ng/L,which were higher than those in control group [(0.02 ± 0.01 )μ g/L,(82.61 ± 26.23) ng/L] (P ＜ 0.05).The serum cTnI and IL-6 levels increased with increasing degrees of poisoning.The different degrees of poisoning was positively correlated with the serum cTnI and IL-6 levels (r =0.642,0.517,P ＜ 0.05).Conclusions The degrees of poisoning,myocardial damage and inflammatory reaction of AOPP patients are closely related to the serum cTnI and IL-6 levels.The dynamic observation of the serum cTnI and IL-6 levels has an important significance for the judging the severity of myocardial damage and inflammatory reaction of AOPP patients.
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Objective To explore the relationship between serum cardiac troponin I (cTnI) and high sensitivity C-reactive protein (hs-CRP),tumor necrosis factor-alpha (TNF-α ) in patients with acute organophosphorus pesticide poisoning (AOPP) and their clinical significance.Methods One hundred and twelve patients with AOPP (without sudden death ) were as AOPP group.One hundred and twelve healthy controls were as control group.Serum cTnI,hs-CRP and TNF-α levels were determined by ELISA and compared between two groups.The relationship between serum cTnI and hs-CRP,TNF-α was analyzed.Time for atropinization and acetylcholinesterase activity recovery and days of hospitalization were observed.The effectiveness of AOPP patients in different serum cTnI levels was compared.Results Serum cTnI,hs-CRP and TNF- α levels in AOPP group[0.75 (0.26,0.99) μ g/L,11.57(5.13,21.62) mg/L,( 12.36 ±5.22) μ g/L] were higher than those in control group[0.01 (0,0.03) μ g/L,3.62(2.31,6.80) mg/L,(7.33 ±4.31 ) μ g/L] (P ＜ 0.01 ).Serum cTnI levels were positive correlation with serum hs-CRP and TNF- α levels in AOPP patients (r =0.53,0.62,P ＜ 0.01 ).Time for atropinization and acetylcholinesterase activity recovery and days of hospitalization in higher serum cTnI levels patients ( 56 cases ) [(7.31 ± 1.96),( 15.29 ± 3.66 ),(17.23 ± 3.62) d] was longer than that in lower serum cTnI levels patients (56 cases)[(5.32 ± 1.03),( 11.32 ± 2.59),( 13.66 ± 3.03) d](P＜ 0.01).Conclusions Cardiac insults in AOPP patients are related to inflammation.Sudden death-free AOPP patients with higher cTnI levels have less response to treatments.
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Objective In order to extrapolate the respiratory dysfunction of patients in early stage of acute organophosphorus pesticide poisoning (AOPP),transpulmonary thermodilution technique was used in swine models of severe acute dichlorvos poisoning (SADP) to evaluate respiratory function.Methods Twenty healthy female swine were randomly divided into dichlorvos ( n =7 ),atropine ( n =7 ) and control (n =6) groups.In the dichlorvos group,the swine were administered with 80％ emulsified dichlorvos (100mg/kg) via the gastric tube toinduce SADP.In the atropine group,swinewere administered with dichlorvos,and 0.5h later,atropine was injected to obtain and maintain atropinization.The swine of control group were administered with saline solution instead.Arterial and venous blood samples were collected 0,0.5,1,2,4 and 6 hours after modeling for blood gas analysis and detecting acetylcholinesterase levels.Both extravascular lung water index (EVLWI) and pulmonary vascular permeability index ( PVPI ) were measured by using PiCCO (pulse indicator continuous cardiac output ). At the termination of the experiment,the animals were sacrificed and the lung wet/dry weight ratio was determined and histopathological changes of lung tissue were also observed under microscope.Results In the dichlorvos group,EVLWI and PVPI were substantially increased from 0.5 h to 6 h after modeling but PaO2/FiO2 decreased from 0-6 h after modeling.In the atropine group,EVLWI and PVPI increased initially,but then they decreased 1 h afterwards and PaO2/FiO2 was also gradually decreased from 0-1 h.In both dichlorvos group and atropine group,the EVLWI was negatively correlated with PO2/FiO2 and positively correlated with PVPI.Compared with the control group,the lung wet/dry weight ratio increased markedly in the dichlorvos group and mildly increased in the atropine group.Meanwhile,the histopathological changes of lung tissue were obvious in the dichlorvos group and mild in the atropine group.Conclusions SADP swine experienced substantial changes in respiratory function. EVLWI was a reliable and valuable indicator for evaluating respiratory function in the early stage of AOPP.
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Objective To investigate the expression and clinical significance of early-stage serum interieukin-10 (IL-10) and tumor necrosis factor-α (TNF-α) in patients with acute organophosphorus pesticide poisoning (AOPP). Method 186 cases of AOPP were divided into mild group, moderate group and severe group according to the severity. 30 healthy volunteers served as control group. APACHE Ⅱ scores were evaluated for these patiences and their serum concentrations of IL-10 and TNF-α were detected by enzyme-linked immunosorbent assay (ELISA). Results APACHE Ⅱ scores increased significantly with the exacerbations of AOPP (P ＜0. 05). The serum IL-10 concentrations of AOPP was slightly higher than the control group. There was no significant difference compared with the control group (P ＞0. 05). APACHE Ⅱ scores positively correlated with the serum TNF-α concentrations, but not with the serum IL-10. However,the ratio of TNF-α and IL-10 positively correlated with APACHE Ⅱ scores ( P ＜ 0. 01 ). Conclusions There were pro-inflammatory response and anti-inflammatory response in patients with AOPP. Overrelease of inflammation promoting factor and imbalance between inflammation promoting and inhibiting factors correlated with the severity of AOPP, which may be an important mechanism of multiple organ dysfunction syndrome of AOPP.
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Objective To study the effect of oral administration of activated charcoal and mannitol on removing toxicant after acute organophosphorus pesticide poisoning (AOPP). Method A total of 41 patients with severe AOPP were randomly divided into experiment group (activated charcoal used as adsorbent and mannitol used as cathartics, n =21)and control group (without adsorbent and cathartics, n = 20). Patients of both groups received routine treatment for AOPP after admission to hospital. The differences in duration of atropinization, the length of hospitalization and the success rate of treatment were compared between two groups. Results There were significant differences in duration of atropinization, the success rate of treatment and hospitalization time between the two groups. Conclusions The combination of activated charcoal and mannitol is more effective than the conventional gastric lavage on removal of organophosphorus pesticides from G-I tract, shorting the duration of atropinization time and hospital stays, and enhancing the success rate of rescue as well as improving the outcome of patients after organophosphorus pesticide poisoning.
ABSTRACT
Objective To observe the effects of long-acting Tuoning and atropine in the treatment of acute organophosphorus pesticide poisoning(AOPP).Methods A total of 97 cases of AOPP were randomly divided into therapy group(n=50) and control group(n=47).Therapy group were treated with long-acting Tuoning combined with pyraloximin methochloridum,and control group were treated with atropine and pyraloximin methochloridum.The effects were compared.Results Long-acting Tuoning could shorten the time of apparent manifestation of AOPP(M-like symptom disappearance time was 1.2h in therapy group and 5.0h in control group,with a significant difference,P