重度有机磷中毒时心肌损伤的特点

Features of myocardial injury in severe organophosphate poisoning.

作者信息

Cha Y S, Kim H, Go J, Kim T H, Kim O H, Cha K C, Lee K H, Hwang S O

机构信息

Department of Emergency Medicine, Wonju College of Medicine, Yonsei University , Wonju , Republic of Korea.

出版信息

Clin Toxicol (Phila). 2014 Sep-Oct;52(8):873-9. doi: 10.3109/15563650.2014.944976. Epub 2014 Aug 12.

DOI:10.3109/15563650.2014.944976

PMID:25116419

Abstract

BACKGROUND

In organophosphate (OP) poisoning cardiac complications may occur. However, the current body of knowledge largely consists of limited studies, and case reports are mainly on electrocardiogram (ECG) abnormalities. As definite myocardial injury is difficult to assess through ECG, we investigated the prevalence of myocardial injury through cardiac biochemical markers such as troponin I (TnI) in severe OP poisoning.

METHODS

We conducted a retrospective review of 99 consecutive OP insecticide poisoning cases that were diagnosed and treated at the emergency department of the Wonju Severance Christian Hospital between March 2008 and December 2013.

RESULTS

Based on Namba classification for OP poisoning, there were no patients with mild toxicity, 9 patients (9.1%) with moderate toxicity and 90 patients (90.9%) with severe toxicity. On ECG, normal sinus rhythm was most common, and ST depression and elevation were seen in 11 patients (11.1%). Elevation of TnI within 48 h was seen in 34 patients (34.3%). The median peak level and peak time of TnI were 0.305 (IQR, 0.078-2.335) ng/mL and 15 (IQR 6.9-34.4) hours, respectively. There were differences between patients with normal TnI and elevated TnI in terms of age (yrs), number of patients who were exposed to OP via the oral route, and initial Glasgow Coma Scale (GCS; 58 ± 17 vs. 66 ± 16, p = 0.015, 56 [87.5%] vs. 33 [97.1%], p = 0.048 and 12.0 [IQR, 8.0-15.0] vs. 9.0 [IQR, 5.8-12.0], p = 0.019).

CONCLUSIONS

OP can cause direct myocardial injury during the acute early phase in severe OP poisoning. Monitoring of TnI may be needed in severe OP poisoning.

摘要

背景

有机磷（OP）中毒时可能会出现心脏并发症。然而，目前的知识体系主要由有限的研究组成，且病例报告主要关注心电图（ECG）异常。由于通过心电图难以评估明确的心肌损伤，我们通过心肌生化标志物如肌钙蛋白I（TnI）来研究重度OP中毒时心肌损伤的发生率。

方法

我们对2008年3月至2013年12月在原州Severance基督教医院急诊科诊断和治疗的99例连续OP杀虫剂中毒病例进行了回顾性研究。

结果

根据OP中毒的难波分类，无轻度中毒患者，9例（9.1%）中度中毒患者，90例（90.9%）重度中毒患者。心电图方面，正常窦性心律最为常见，11例（11.1%）患者出现ST段压低和抬高。34例（34.3%）患者在48小时内TnI升高。TnI的中位峰值水平和峰值时间分别为0.305（四分位间距，0.078 - 2.335）ng/mL和15（四分位间距6.9 - 34.4）小时。TnI正常和升高的患者在年龄（岁）、经口服途径接触OP的患者数量以及初始格拉斯哥昏迷量表（GCS）方面存在差异（58 ± 17 vs. 66 ± 16，p = 0.015；56 [87.5%] vs. 33 [97.1%]，p = 0.048；12.0 [四分位间距，8.0 - 15.0] vs. 9.0 [四分位间距，5.8 - 12.0]，p = 0.019）。