急性有机磷中毒的系列神经电生理研究——与临床发现、血清胆碱酯酶水平及阿托品剂量的相关性

Serial neuro-electrophysiological studies in acute organophosphate poisoning--correlation with clinical findings, serum cholinesterase levels and atropine dosages.

作者信息

Avasthi G, Singh G

机构信息

Department of Medicine, Dayanand Medical College, Ludhiana 141 001, Punjab, India.

出版信息

J Assoc Physicians India. 2000 Aug;48(8):794-9.

PMID:11273471

Abstract

OBJECTIVES AND METHODS

A prospective evaluation of the correlation between the serial clinical findings, serum cholinesterase levels, electrodiagnostic abnormalities and the daily atropine requirement was undertaken in 29 patients with confirmed acute organophosphate poisoning (OPP).

RESULTS

Clinical weakness conforming to the pattern found in 'Intermediate Syndrome' was noted in 19 patients (65.55%). It was associated with all types of organophosphate compounds and occurred in all patients in whom the serum cholinesterase on admission was less than 200 units. Three types of electrodiagnostic abnormalities were noted: single supramaximal electrical stimulus induced repetitive response, a decrement--increment response to 30 Hz repetitive nerve stimulation (RNS) and a decremental responses to 30 Hz RNS. The 30 Hz decremental response correlated best with the presence of clinically detectable weakness (sensitivity = 61.72%; specificity = 81.54%; positive predictive value = 73.91%; negative predictive value = 71.62%). Time trends evaluation revealed that the peak daily atropine dosages were given at a mean of 1.76 +/- 0.83 days in comparison to a mean nadir of serum cholinesterase of 2.48 +/- 1.97 days and a mean nadir of 9:1 ratio of 2.65 +/- 1.76 days. The 2-tailed correlation coefficient analysis and simple regression analysis revealed a positive correlation between serum cholinesterase levels and the 9:1 ratios (correlation coefficient: 0.59). A negative correlation was observed between the 9:1 ratios and the daily atropine requirement (correlation coefficient: -0.57) and between serum cholinesterase levels and daily atropine requirement (correlation coefficient: -0.49).

CONCLUSIONS

At admission, level of serum cholinesterase of less than 200 units is a predictor and the 30 Hz RNS decremental response could be a useful marker for the 'Intermediate Syndrome'.

摘要

目的与方法

对29例确诊为急性有机磷中毒（OPP）的患者进行前瞻性评估，分析其系列临床检查结果、血清胆碱酯酶水平、电诊断异常与每日阿托品需求量之间的相关性。

结果

19例患者（65.55%）出现符合“中间综合征”模式的临床肌无力。其与所有类型的有机磷化合物有关，且在入院时血清胆碱酯酶低于200单位的所有患者中均有发生。记录到三种类型的电诊断异常：单次超强电刺激诱发重复反应、对30Hz重复神经刺激（RNS）的递减-递增反应以及对30Hz RNS的递减反应。30Hz递减反应与临床可检测到的肌无力相关性最佳（敏感性=61.72%；特异性=81.54%；阳性预测值=73.91%；阴性预测值=71.62%）。时间趋势评估显示，每日阿托品剂量峰值平均在1.76±0.83天给予，而血清胆碱酯酶平均最低点在2.48±1.97天出现，9:1比值的平均最低点在2.65±1.76天出现。双尾相关系数分析和简单回归分析显示血清胆碱酯酶水平与9:1比值之间呈正相关（相关系数：0.59）。9:1比值与每日阿托品需求量之间呈负相关（相关系数：-0.57），血清胆碱酯酶水平与每日阿托品需求量之间也呈负相关（相关系数：-0.49）。