Objective To formulate an optimal treatment for patients with acute organophosphorus pesticide poisoning through the evidence-based approach. Methods Based on the clinical questions raised from a real-life patient of acute organophosphorus pesticide poisoning (OP poisoning) in Emergency ICU (EICU), we searched ACP journal club (1991-April, 2006), The Cochrane Library (Issue 1, 2006), MEDLINE (1966-May 2006) and Chinese Biological Medical Database(1978-May 2006) for systematic reviews , clinical randomized controlled trials, cohort and case-control studies using the keywords of “organophosphorus compounds, poisoning, insecticides, oximes, cholinesterase reactivators, and intermediate syndrome”. The quality of the included studies was assessed. Results One Cochrane systematic review and one meta-analysis were included. These two studies concluded that there was no clear evidence on the benefits of oximes for acute organophosphorus pesticide poisoning. Based on the current evidence, integrated with clinical expertise and the patients’ values, the oximes were not used for this patient, only low-dose atropine was administered with other supportive therapies. After one week of treatment, the patient was discharged since her vital signs were stable and clinical symptoms were relieved. Conclusions The appropriate management for acute organophosphorus pesticide poisoning has been formulated with the approach of evidence-based medicine. Large-scale, methodologically-sound trials are required.
摘要:目的:探討有機磷農藥中毒患者阿托品使用方法,提高搶救成功率。方法: 對2005年6月至2009年6月我院收治的有機磷農藥中毒病人281例進行分組,所有患者均使用阿托品療法,A組為2007年以后132例序貫阿托品療法患者,B組2007年以前為常規使用靜推繼之肌注阿托品療法149例患者,根據有機磷農藥對膽堿酯酶復能劑的療效分為高效組和低效組,并結合病情嚴重程度共分為重度有機磷農藥中毒膽堿酯酶復能劑高效組、重度有機磷農藥中毒膽堿酯酶復能劑低效組,輕度有機磷農藥中毒膽堿酯酶復能劑高效組、輕度有機磷農藥中毒膽堿酯酶復能劑低效組4組,分別從達到阿托品化時間、維持阿托品化效果、反跳和中間綜合征發生率、開始撤藥平均時間、總住院費用、總住院平均時間、護士勞動強度進行總結和分析。結果: 維持阿托品化療效Ａ組與B組間有顯著差異,P值lt;0.01,開始撤藥平均時間、總住院平均時間、總住院費用、護士勞動強度Ａ組與B組間均有差異,P值lt;0.05,發生反跳和中間綜合征發生率、達到阿托品化時間在高效組間比較無差異,低效組間比較無差異,高效組與低效組比較有顯著差異,P值lt;0.01,主要與中毒藥物種類和病情嚴重程度有關,其次與阿托品治療方法有關。 結論: 序貫阿托品療法治療有機磷農藥中毒優于常規使用靜推繼之肌注阿托品療法。Abstract: Objective: To discussion of atropine in organophosphorus pesticide poisoning patients with the use of two different methods to improve the success rate. Methods: For June 2005 to June 2009 inour hospital a total of organophosphorus pesticide poisoning 281 cases were divided into A group and B group, All patients were using atropine therapy, 132 cases of sequential therapy in patients with atropine is divided into A group, 149 cases of routine use of intravenous injection and intramuscular injection of atropine group patients were divided into B group, From the following aspects were analyzed and summarized, They are the maintenance of the effect of atropinization, the average time for the beginning of withdrawal, the total hospitalization costs, the total average time for hospitalization and nurses labor intensity. According to the organic phosphorus pesticide on the efficacy of cholinesterase agents are divided into efficient and inefficient groups groups, From the types of poisons, toxic ways, poisoning performance and Complications for stratified, They were divided into 4 groups, severe organophosphorus pesticide poisoning and cholinesterase reactivator can be highly effective group, severe organophosphorus pesticide poisoning and cholinesterase reactivator Lowefficacy group, mild organophosphorus pesticide poisoning and cholinesterase reactivator can be highly effective group, mild organophosphorus pesticide poisoning and cholinesterase reactivator Lowefficacy group, Correlation analysis Antijumping and the incidence of intermediate syndrome and atropinization time.Results:Maintain the efficacy of atropine of A group and B were significantly different between groups, Plt;0.01, the average time began to withdraw drugs, the total average time for hospitalization, total hospital charges, nursing labor intensity of A group and B are differences between the two groups, P＜0.05. Rebound occurs and the incidence of intermediate syndrome, to atropinization time high between the two groups showed no difference between the two groups showed no differences between inefficient and efficient group and inefficient group were significantly different, Plt;0.01, mainly related to poisoning by drug type and severity of illness, followed with atropine therapy. Conclusion:Atropine sequential therapy is superior to organophosphorus pesticide poisoning by conventional atropine treatmen.
