Shihana Fathima, Dawson Andrew H, Dobbins Timothy, Dissanayake Dhammika, Buckley Nicholas A
a South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine , University of Peradeniya , Peradeniya , Sri Lanka ;
b NSW Poisons Information Centre, The Children's Hospital , Westmead , NSW , Australia ;
Clin Toxicol (Phila). 2016 Aug;54(7):576-80. doi: 10.1080/15563650.2016.1177651. Epub 2016 May 19.
In 2008, self-poisoning with the herbicide propanil had a case-fatality of around 11% in Sri Lanka. A simple quantitative methaemoglobinemia bedside test was developed so that treatment could be titrated according to the methaemoglobin level.
To determine whether the new method influenced patient management and changed the case fatality of propanil self-poisoning.
The bedside test (using an inexpensive validated colour chart) was introduced in three hospitals (Anuradhapura, Polonnaruwa and Galle) in Sri Lanka from 2008. Junior ward staff were given a brief training on how to use the chart for quantitative estimation of methaemoglobin in patients with propanil poisoning and utilize the results in the context of the national treatment guidelines for propanil poisoning. It was taught that the bedside test should be done repeatedly from admission until it showed consistently low values of methaemoglobin. Treatment with the antidote methylene blue was suggested for patients whose methaemoglobin was greater than 20%. Limited clinical data on poisoning have been prospectively collected from these hospitals from 2003. The case-fatality and management before and after the change were compared with data up to December 2014.
The case-fatality decreased from (38/401) 9.5% to (8/262) 3.1% [difference: -6.4%, 95% CI: -10 to -3]. Methylene blue use increased from under 10% of patients before to 55% of patients after the intervention. More patients received repeat doses and infusions, and few received ascorbic acid and exchange transfusion.
The simple bedside test for methaemoglobinemia was readily adopted into routine practice and led to large changes in management. A substantial reduction in mortality from propanil poisoning occurred after this intervention.
2008年，在斯里兰卡，使用除草剂敌稗进行自我中毒的病例死亡率约为11%。为此开发了一种简单的定量高铁血红蛋白血症床旁检测方法，以便能根据高铁血红蛋白水平调整治疗方案。
确定新方法是否会影响患者管理并改变敌稗自我中毒的病例死亡率。
2008年起，在斯里兰卡的三家医院（阿努拉德普勒、波隆纳鲁沃和加勒）引入了床旁检测（使用经过验证的廉价色卡）。对初级病房工作人员进行了简短培训，内容是如何使用该色卡对敌稗中毒患者的高铁血红蛋白进行定量估计，并根据国家敌稗中毒治疗指南利用检测结果。培训内容包括，从入院开始应反复进行床旁检测，直至高铁血红蛋白值持续较低。对于高铁血红蛋白大于20%的患者，建议使用解毒剂亚甲蓝进行治疗。自2003年起，前瞻性收集了这些医院关于中毒的有限临床数据。将这一改变前后的病例死亡率和管理情况与截至2014年12月的数据进行了比较。
病例死亡率从（401例中的38例）9.5%降至（262例中的8例）3.1%[差异：-6.4%，95%可信区间：-10%至-3%]。亚甲蓝的使用从干预前不到10%的患者增加到干预后55%的患者。更多患者接受了重复剂量和输液治疗，很少有患者接受抗坏血酸和换血治疗。
高铁血红蛋白血症的简单床旁检测方法很容易被纳入常规实践，并导致了管理方面的重大改变。此次干预后，敌稗中毒的死亡率大幅降低。
