Reji Kent K, Mathew Vivek, Zachariah Anand, Patil Anil Kumar B, Hansdak Samuel George, Ralph Ravikar, Peter John Victor
a Department of Neurology , Christian Medical College , Vellore , Tamil Nadu , India ;
b Department of Medicine , Christian Medical College , Vellore , Tamil Nadu , India ;
Clin Toxicol (Phila). 2016 Mar;54(3):259-65. doi: 10.3109/15563650.2015.1126841. Epub 2016 Jan 6.
There is limited information on extrapyramidal symptoms in acute organophosphate (OP) poisoning. We describe the course and outcome of severely poisoned patients who develop extrapyramidal manifestations.
In this prospective observational study, spanning 8 months (Apr-Nov 2013) adult patients (>18 years) admitted with OP poisoning were enrolled. Patients on anti-psychotic therapy, those refusing consent or presenting with co-ingestions were excluded. Treatment included atropine and supportive care (e.g. ventilation and inotropes as indicated); oximes were not administered. The presence of rigidity, tremors, dystonia and chorea were assessed daily till discharge using modifications of the Unified Parkinson's Disease rating scale and the Tremor rating scale. The presence of extrapyramidal manifestations was correlated with length of ventilation and hospital stay and mortality.
Of the 77 patients admitted with OP poisoning, 32 were enrolled; 17 (53.1%) developed extrapyramidal manifestations which included rigidity (94.1%), tremors (58.8%) and dystonia (58.8%). None developed chorea. The median (inter-quartile range) time of symptom onset was 8 (5-11) days; extrapyramidal features resolved in 11 (6-17) days. The median duration of intensive care stay in patients not developing extrapyramidal symptoms was 6 (2-8) days, indicating that most of these patients had recovered even before symptom onset in patients who developed extrapyramidal manifestations. Overall, 27/32 (84%) were ventilated. Hospital mortality was 6.25% (2/32). When compared with patients not developing extrapyramidal signs, those with extrapyramidal manifestations had significantly prolonged ventilation (5 versus 16 median days; p = 0.001) and hospitalization (8 versus 21 days; p < 0.001), reduced ventilator-free days (23 versus 12 days; p = 0.023) and increased infections (p = 0.03). The need for ventilation and mortality were not significantly different (p > 0.6). Extrapyramidal symptoms were not observed in non-OP poisoned patients with prolonged ICU stay.
In this small series of acute OP poisoning, extrapyramidal manifestations were common after 1 week of intensive care but self-limiting. They are significantly associated with longer duration of ventilation and hospital stay.
关于急性有机磷（OP）中毒时锥体外系症状的信息有限。我们描述了出现锥体外系表现的重度中毒患者的病程及结局。
在这项为期8个月（2013年4月至11月）的前瞻性观察研究中，纳入了因OP中毒入院的成年患者（>18岁）。排除接受抗精神病治疗的患者、拒绝同意或伴有合并摄入其他物质的患者。治疗包括阿托品及支持治疗（如根据需要进行通气和使用血管活性药物）；未使用肟类药物。每天使用改良的统一帕金森病评定量表和震颤评定量表评估是否存在强直、震颤、肌张力障碍和舞蹈症，直至出院。锥体外系表现的出现与通气时间、住院时间及死亡率相关。
77例因OP中毒入院的患者中，32例被纳入研究；17例（53.1%）出现锥体外系表现，包括强直（94.1%）、震颤（58.8%）和肌张力障碍（58.8%）。无人出现舞蹈症。症状出现的中位（四分位间距）时间为8（5 - 11）天；锥体外系特征在11（6 - 17）天内消失。未出现锥体外系症状的患者重症监护住院时间的中位数为6（2 - 8）天，这表明这些患者中的大多数在出现锥体外系表现的患者症状出现之前就已康复。总体而言，27/32（84%）患者接受了通气治疗。医院死亡率为6.25%（2/32）。与未出现锥体外系体征的患者相比，出现锥体外系表现的患者通气时间显著延长（中位数分别为5天和16天；p = 0.001）、住院时间延长（8天和21天；p < 0.001）、无通气天数减少（23天和12天；p = 0.023）且感染增加（p = 0.03）。通气需求和死亡率无显著差异（p > 0.6）。在ICU住院时间延长的非OP中毒患者中未观察到锥体外系症状。
在这一小系列急性OP中毒患者中锥体外系表现在重症监护1周后很常见，但为自限性。它们与通气时间和住院时间延长显著相关。
