Schrickel Jan Wilko, Lewalter Thorsten, Lüderitz Berndt, Nickenig Georg, Klehr Hans-Ulrich, Rabe Christian
Department of Internal Medicine II, University of Bonn, Bonn, Germany.
J Emerg Med. 2009 Oct;37(3):279-82. doi: 10.1016/j.jemermed.2007.11.006. Epub 2008 Feb 20.
Organophosphate poisoning is associated with a high mortality rate due to respiratory failure, dysrhythmias, and multi-organ failure. We report two cases of survival after "in-the field" antidote treatment of very severe organophosphate poisonings. Two patients orally ingested large amounts of the organophosphorous agent oxydemeton-methyl in suicide attempts, resulting in the hypercholinergic syndrome in both. Resuscitation included early administration of antidote by emergency medical personnel as well as high-dose atropine. Plasma levels of pseudo cholinesterase were initially very low in both patients. Long-term mechanical ventilation was necessary, and both patients developed aspiration pneumonia. At discharge, no major neurological deficits were present. Prompt antidote treatment and aggressive supportive emergency and intensive care unit therapy contribute to improved survival after acute organophosphate poisoning. We believe that in cases of mass poisonings--for example, terrorist activity--therapy must be available on the scene as soon as possible. This also may require decentralized antidote storage.
有机磷中毒因呼吸衰竭、心律失常和多器官功能衰竭而死亡率很高。我们报告两例经“现场”解毒剂治疗的极其严重的有机磷中毒后存活的病例。两名患者为自杀而口服了大量有机磷制剂氧化乐果，均导致了高胆碱能综合征。复苏措施包括急救人员早期给予解毒剂以及大剂量阿托品。两名患者最初的血浆假性胆碱酯酶水平都非常低。都需要长期机械通气，且两名患者均发生了吸入性肺炎。出院时，未出现重大神经功能缺损。及时的解毒剂治疗以及积极的支持性急诊和重症监护病房治疗有助于提高急性有机磷中毒后的存活率。我们认为，在发生大规模中毒事件时，例如恐怖活动，必须尽快在现场提供治疗。这可能还需要分散储存解毒剂。
