Medical Intensive Care Unit, Christian Medical College and Hospital, Vellore, India.
Clin Toxicol (Phila). 2010 Nov;48(9):916-23. doi: 10.3109/15563650.2010.528425.
The two major classes of organophosphate compounds, dimethyl and diethyl organophosphates, have different toxicokinetic properties. This study evaluated the clinical profile and outcomes in patients admitted with poisoning with these two classes of organophosphates.
This retrospective study spanned 6 years (2002-2007). Patients were treated with atropine and supportive care including ventilation, as required, and followed up until death or hospital discharge. Oximes were not administered. Of the 422 charts retrieved, 396 fulfilled inclusion criteria. Data on the clinical profile, ventilation, length of hospital stay, incidence of intermediate syndrome and mortality were extracted.
The mean (± standard deviation) age was 31.4 ± 12.7 years with a male preponderance (2.6:1). The median (interquartile range (IQR)) admission pseudocholinesterase level of 317 (222-635) U/L indicated significant inhibition of cholinesterase activity. The median lag-time to presentation to our hospital was 5 (IQR 3-8.5) hours. Oximes were administered at a primary center in 33 patients (8.3%). Dimethyl organophosphate was ingested by 141 patients, diethyl organophosphate by 108, S-alkyl organophosphate by 2, and an un-identified organophosphate by 145 patients. Ventilation was required in 260 patients (65.7%); the median duration of ventilation being 7.5 (IQR 3-12) days. Overall mortality was 13.1%. There was a significant difference between dimethyl and diethyl organophosphate compounds in ventilatory requirement (76% vs. 56%, adjusted odds ratio (OR) 2.37, 95% CI 1.01-5.57, p=0.047), duration of ventilation (11 (4-15) vs. 5 (2-9) days, adjusted OR 1.12, 95%CI 1.04-1.21, p=0.002) and incidence of intermediate syndrome (72/125 (58%) vs. 24/92 (26%), adjusted OR 2.84, 95%CI 1.38-5.86, p=0.004). Mortality was similar in the two groups (20/141 (14%) vs. 7/108 (6%), dimethyl vs. diethyl organophosphate, adjusted OR 1.29, 95%CI 0.43-3.94, p=0.65).
Patients admitted with dimethyl organophosphate poisoning have a worse outcome compared with diethyl organophosphate poisoning for clinically relevant patient outcomes.
评估两类有机磷化合物（二甲和二乙基有机磷）中毒患者的临床特征和结局。
这是一项回顾性研究，时间跨度为 6 年（2002-2007 年）。患者接受了阿托品和支持性治疗，包括必要时的通气，并随访至死亡或出院。未给予肟类药物。从检索到的 422 份图表中，有 396 份符合纳入标准。提取了临床特征、通气、住院时间、中间综合征发生率和死亡率的数据。
平均（±标准偏差）年龄为 31.4±12.7 岁，男性居多（2.6:1）。中位（四分位间距（IQR））入院假性胆碱酯酶水平为 317（222-635）U/L，表明胆碱酯酶活性受到显著抑制。中位到达我院的时间为 5（IQR 3-8.5）小时。33 名患者（8.3%）在一级中心接受了肟类药物治疗。141 名患者摄入了二甲有机磷，108 名患者摄入了二乙基有机磷，2 名患者摄入了 S-烷基有机磷，145 名患者摄入了未知的有机磷。260 名患者（65.7%）需要通气；通气中位数持续时间为 7.5（IQR 3-12）天。总体死亡率为 13.1%。二甲和二乙基有机磷化合物在通气需求方面存在显著差异（76% vs. 56%，调整后的优势比（OR）2.37，95%CI 1.01-5.57，p=0.047），通气持续时间（11（4-15）vs. 5（2-9）天，调整后的 OR 1.12，95%CI 1.04-1.21，p=0.002）和中间综合征的发生率（72/125（58%）vs. 24/92（26%），调整后的 OR 2.84，95%CI 1.38-5.86，p=0.004）。两组死亡率相似（20/141（14%）vs. 7/108（6%），二甲 vs. 二乙基有机磷，调整后的 OR 1.29，95%CI 0.43-3.94，p=0.65）。
与二乙基有机磷中毒相比，二甲有机磷中毒患者的临床相关结局更差。
