Department of Clinical Toxicology, II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
Chem Biol Interact. 2013 Dec 5;206(3):561-8. doi: 10.1016/j.cbi.2013.05.003. Epub 2013 May 17.
Organophosphate (OP) poisoning is still associated with high morbidity and mortality rates, both in resource-poor settings and in well-developed countries. Despite numerous publications dealing with this particular poison, detailed clinical data on more severe overdoses with these agents are relatively sparsely reported. A retrospective study was consequently conducted on 33 patients with OP poisoning admitted to our intensive care unit (ICU) to provide additional data on clinical features. We included moderate to severe poisonings between 2000 and 2012 who required admission to ICU. Patients ingested dimethyl-OPs in 19 cases, diethyl-OPs in 8 cases and otherwise classified OPs in 6 cases. Death (5/33) occurred rather late and only one of these fatalities died during on-going cholinergic crisis. Of the survivors (28/33), 71% recovered fully while 29% showed predominantly neurological disabilities before being transferred to neurologic rehabilitation. Aspiration pneumonia predominated in 27/33 patients and one patient died in refractory acute respiratory distress syndrome (ARDS). The intermediate syndrome occurred twice and cardiopulmonary resuscitation had to be performed in 6/33 patients. Fatalities showed a higher Poison-severity-score, APACHE-II-score and SOFA-score on admission compared with survivors and they showed significantly longer QTc-time in the ECG, lower systolic blood pressure and heart rate, a lower pH and a lower base excess on admission. Patients with diethyl-OPs required intubation significantly earlier and showed lower and more sustained inhibited activity of the plasma-cholinesterase on admission compared with patients ingesting dimethyl-OPs. Treatment with atropine and obidoxime was comparable between these groups and severity of poisoning, outcome, hemodynamics on admission, duration of mechanical ventilation and length of stay in the ICU did not significantly differ between the involved group of dimethyl- and diethyl-OPs. We conclude that the fatality rate in our patient cohort treated in a well-staffed and equipped ICU of a developed country is quite similarly high compared with the rate observed in developing countries. Patients died rather late when severe cholinergic crisis had mostly been overcome and death was therefore related to non-poison specific complications.
有机磷（OP）中毒在资源匮乏的环境和发达国家仍然与高发病率和死亡率相关。尽管有许多出版物涉及这种特殊的毒药，但关于这些药物更严重的过量使用的详细临床数据相对较少。因此，对我院重症监护病房（ICU）收治的 33 例有机磷中毒患者进行了回顾性研究，以提供有关临床特征的额外数据。我们纳入了 2000 年至 2012 年期间中至重度中毒且需要入住 ICU 的患者。19 例患者摄入了二甲氧基 OP，8 例患者摄入了二乙氧基 OP，6 例患者摄入了其他 OP。死亡（33 例患者中有 5 例）发生得较晚，只有 1 例在持续的胆碱能危象期间死亡。在幸存者（33 例患者中有 28 例）中，71%完全康复，而 29%在转入神经康复之前表现出主要的神经功能障碍。27/33 例患者发生吸入性肺炎，1 例患者死于难治性急性呼吸窘迫综合征（ARDS）。中间综合征发生了 2 次，6/33 例患者需要心肺复苏。死亡患者入院时的中毒严重程度评分、急性生理与慢性健康评分（APACHE-Ⅱ）和序贯器官衰竭评分（SOFA）均高于幸存者，入院时心电图 QTc 时间明显延长，收缩压和心率较低，pH 值和碱剩余较低。摄入二乙氧基 OP 的患者需要插管的时间明显更早，入院时血浆胆碱酯酶活性抑制程度更低且持续时间更长。与摄入二甲氧基 OP 的患者相比，入院时接受阿托品和肟碘解磷定治疗的两组患者之间差异无统计学意义，中毒严重程度、预后、入院时血流动力学、机械通气时间和 ICU 住院时间在涉及二甲氧基和二乙氧基 OP 的两组患者之间无显著差异。我们得出结论，在发达国家设备齐全、人员配备完善的 ICU 中治疗的患者队列的死亡率与发展中国家观察到的死亡率相当高。当严重的胆碱能危象基本得到控制时，患者死亡较晚，因此与非中毒特异性并发症有关。
