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BACKGROUND: To evaluate the efficacy and safety of Xuebijing injection (XBJ) treatment for acute organophosphorus pesticide poisoning. METHODS: Using the PubMed, Cochrane, Embase, Sinomed, Wanfang, CNKI, and Weipu (VIP) databases from the beginning of the datasets until December 2017, all of the relevant randomized controlled trials were identified. Relative risks (RR), weighted mean difference (WMD), along with 95% confidence interval (95% CI) were used to analyze the main outcomes. Statistical analysis was performed using the RevMan software version 5.3. The qualities of the involved studies were assessed by the risk of bias according to the Cochrane handbook. RESULTS: Twenty-six randomized controlled trials with 1,880 participants were collected in total. Compared with just conventional therapy alone, XBJ combined with conventional therapy significantly reduced the 7-day mortality rate (RR: 0.33; 95% CI: 0.22-0.49), CRP in the 50 mL group (WMD: -11.60; 95% CI: -14.38 to -8.83), CRP in the 100 mL group (WMD: -1.73; 95% CI: -2.91 to -0.55), AChE in the 50 mL group (WMD: -4.58;95% CI: -5.87 to -3.28), AChE in the 100 mL group (WMD: -1.73; 95% CI: -2.07 to -1.39), hospital stays in the 50 mL group (WMD: -4.26; 95% CI: -4.89 to -3.64), TNF-α in the 50 mL group (WMD: -2.66; 95% CI: -4.99 to -0.32), NF-κB in the 50 mL group (WMD: -13.07; 95% CI: -14.67 to -11.47), and CK-MB in the 50 mL group (WMD: -32.28; 95% CI: -40.62 to -23.93). However, there was no statistical difference of TNF-α in the 100 mL group (WMD: -2.17; 95% CI: -4.66 to 0.32). CONCLUSIONS: XBJ has a significant clinical efficacy for the treatment of patients with acute organophosphorus pesticide poisoning. The most effective dose is 50 mL, while the most effective frequency is twice a day. However, more studies are needed to confirm the extract efficacy of XBJ.
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BACKGROUND: Acute organophosphorus pesticide poisoning (AOPP) is becoming a significant problem and a potential cause of human mortality because of the abuse of organophosphate compounds. This study aims to determine the independent prognostic factors of AOPP by using multivariate logistic regression analysis. METHODS: The clinical data for 71 subjects with AOPP admitted to our hospital were retrospectively analyzed. This information included the Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, 6-h post-admission blood lactate levels, post-admission 6-h lactate clearance rates, admission blood cholinesterase levels, 6-h post-admission blood cholinesterase levels, cholinesterase activity, blood pH, and other factors. Univariate analysis and multivariate logistic regression analyses were conducted to identify all prognostic factors and independent prognostic factors, respectively. A receiver operating characteristic curve was plotted to analyze the testing power of independent prognostic factors. RESULTS: Twelve of 71 subjects died. Admission blood lactate levels, 6-h post-admission blood lactate levels, post-admission 6-h lactate clearance rates, blood pH, and APACHE II scores were identified as prognostic factors for AOPP according to the univariate analysis, whereas only 6-h post-admission blood lactate levels, post-admission 6-h lactate clearance rates, and blood pH were independent prognostic factors identified by multivariate logistic regression analysis. The receiver operating characteristic analysis suggested that post-admission 6-h lactate clearance rates were of moderate diagnostic value. CONCLUSIONS: High 6-h post-admission blood lactate levels, low blood pH, and low post-admission 6-h lactate clearance rates were independent prognostic factors identified by multivariate logistic regression analysis.
Subject(s)
Lactic Acid/blood , Organophosphate Poisoning/blood , Pesticides/poisoning , APACHE , Acute Disease , Adult , Aged , Biomarkers/blood , Cholinesterases/blood , Female , Humans , Hydrogen-Ion Concentration , Logistic Models , Male , Middle Aged , Multivariate Analysis , Organophosphate Poisoning/mortality , Prognosis , ROC Curve , Retrospective Studies , Risk FactorsABSTRACT
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.
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0.05), but the symptom of fever and character of respiratory tract's secretion of the patients in experiment group took turns for better obviously than the control group's ( P