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@#BACKGROUND: The aim of the present study is to describe the clinical correlates of hypotension and its associated outcomes in patients with acute organophosphorus poisoning (AOPP). METHODS: In this retrospective cohort study, we analyzed data pertaining to 871 patients with AOPP who were treated at two hospitals. Data from hypotensive and non-hypotensive patients were compared to identify clinical correlates of hypotension. We also evaluated the association between clinical parameters (including hypotension) and in-hospital mortality. RESULTS: The incidence of hypotension in AOPP patients was 16.4%. Hypotensive patients showed significantly higher in-hospital mortality (1.1% vs. 39.9%, P<0.001). Advanced age (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.08-1.44), history of diabetes (OR 2.65, 95% CI 1.14-5.96), and increased white blood cell count (OR 1.06, 95% CI 1.03-1.09), plasma cholinesterase (OR 0.91, 95% CI 0.84-0.94), plasma albumin (OR 0.88, 95% CI 0.85-0.92), serum amylase (OR 1.01, 95% CI 1.01-1.02), and blood pH (OR 0.64, 95% CI 0.54-0.75) were significantly associated with hypotension. After adjusting for potential confounders, hypotension was associated with increased in-hospital mortality (hazard ratio 8.77-37.06, depending on the controlled variables). CONCLUSIONS: Hypotension is a common complication of AOPP and is associated with increased in-hospital mortality. Advanced age, history of diabetes, and changes in laboratory parameters were associated with hypotension in AOPP patients.
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Objective To compare therapeutic effect of single hemoperfusion and hemoperfusion combined with continuous veno-venous hemofiltration ( sequential continuous blood purification) on patients with severe acute organophosphate poisoning combined with myocardial injury.Methods A total of 80 patients with severe acute organophosphate poisoning combined with myocardial injury admitted to EICU of Beijing Chaoyang Hospital from Jan.2004 to Dec.2013 were respectively analyzed and divided into two groups: hemoperfusion group (patients collected from Jan.2004 to Dec.2008, n=41) and sequential continuous blood purification (patients collected from Jan.2009 to Dec.2013, n =39).The average cholinesterase recovery time, the average consciousness recovery time, the average doses of atropine, the average hospital time, the change of cardiac troponin I levels on days 1, 2, 3, 5 and 7 after admission, and the change of left ventricular ejection fraction within 24 h after admission and after 24 h following blood purification treatment were compared between the two groups.Results Patients in the sequential continuous blood purification group had less average cholinesterase recovery time, average consciousness recovery time, average doses of atropine and average hospital time compared with patients in the hemoperfusion group [ ( 87.6 ±8.8 ) h vs.( 113.8 ±13.3 ) h;(57.3 ±11.7) h vs.(100.5 ±10.8) h;(284.5 ±61.4) mg vs.(476.6 ±93.1) mg and (10.2 ±2.3) vs. (14.6 ±3.9) , all P<0.01].The levels of cardiac troponin I on days 2, 3, 5 and 7, and ejection fraction of left ventricule after 24 h following blood purification treatment in the sequential continuous blood purification group were significantly decreased compared with patients in the hemoperfusion group ( all P <0.05 ) . Conclusion Therapeutic effect of sequential continuous blood purification on patients with severe acute organophosphate poisoning combined with myocardial injury is superior to single hemoperfusion.It suggests that sequential continuous blood purification could be used as a preferred choice in treatment of patients with severe acute organophosphate poisoning combined with myocardial injury.
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Objective To analyze the risk factors of acute organophosphate pesticide poisoning intermediate syndrome(IMS ),and discuss the corresponding nursing countermeasures. Methods From January 2007 to January 2011,50 cases of patients with acute organophosphate pesticide poisoning were collected as the research object.And we analyzed the risk factors of related intermediate syndrome. Results The incidence rate of acute organophosphate poisoning intermediate syndrome was 10.0％.IMS mainly occurred at age of 20～50 years old,rarely occurred at age of ＜20 and ＞50 years old.The incidence of IMS with oral intake was higher than respiratory poisoning and skin poisoning.The incidence of IMS caused by drugs of moderate toxicity was higher than drugs with high or low toxicity.The incidence of IMS patients who got atropinization within 2 hours was less than those without it.The incidence of IMS patients using aminoglycoside drugs was higher than those not using them. Conclusions Poisoning way,toxicity of toxicant,timely treatment,basic diseases,atropinization within 2 hours,and using aminoglycoside drugs can influence the condition and prognosis of intermediate syndrome caused by organophosphate pesticide poisoning.
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BACKGROUND: Because of the widespread use and availability of agricultural insecticides, acute organophosphate poisoning as a suicide or an accident is becoming the most common type of poisoning and serious problem in Korea. The mortality of organophosphate poisoning varied from 10 to 86 percent. The cause of death was thought to be a combination of excessive bronchial secretion, bronchospasm, respiratory muscle paralysis and depression of respiratory center, summarily respiratory failure. We evaluated the respiratory complications in patients with acute organophosphate intoxication to determine the predisposing factors to respiratory failure and to reduce the incidence of respiratory failure or mortality. METHOD: We conducted a retrospective study of 111 patients with the discharge diagnosis of organophosphate poisoning who were hospitalized at Yenugnam University Hospital during the 5 years. The diagnosis of organophosphate poisoning has based on the followings (1) a history of exposure to an organophosphate compounds. (2) the characteristic clinical signs and symptoms. (3)decrease in the cholinesterase activity in the serum. RESULTS: The results were as follows 1) Respiratory failure developed in 31(28%) of 111 patients with acute organophosphate poisoning. All cases of respiratory failure developed within 96 hours after poisoning and within 24 hours in 23 patients. 2) The 80 patients who did not develop respiratory failure survived. In 31 patients with respiratory failure, 15(44%) patients were dead. 3) The patients with respiratory failure had more severe poisoning, that is, the lower level of serum cholinesterase activity on arrival, the higher mean dosage of atropine administered within first 24 hours. 4) In 16 patients with pneumonia, 14 patients developed respiratory failure. In 5 patients with cardiovascular collapse, 2 patients developed respiratory failure. 5) There was no correlation to between age, sex, the use of pralidoxime and respiratory failure. 6) The serum cholinesterase level in survivors at time of respiratory failure and weaning was 66.05+/-85.48U/L, 441+/-167.49U/L, respectively. CONCLUSION: All the respiratory failure complications of acute organophosphate poisoning occurred during the first 96 hours after exposure. The severity of poisoning and pneumonia were the predisposing factors to respiratory failure. Aggressive treatment and prevention of the above factors will reduce the incidence of respiratory failure.