Department of Physiology, University of Peradeniya, Peradeniya, 20400, Sri Lanka; South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, 20400, Sri Lanka.
Department of Physiology, University of Peradeniya, Peradeniya, 20400, Sri Lanka; South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, 20400, Sri Lanka; School of Psychology, The University of Newcastle, Sydney, Australia.
Neurotoxicology. 2018 Dec;69:209-216. doi: 10.1016/j.neuro.2017.12.002. Epub 2017 Dec 5.
Ingestion of organophosphorus insecticides (OPI) is a common method of deliberate self harm in the developing world. Deaths mainly follow as a result of the respiratory failure associated with both cholinergic crisis and the intermediate syndrome. Even though death can be prevented by early mechanical ventilation of these patients, limited studies are available regarding the prediction of intermediate syndrome and subsequent respiratory failure.
To systematically review articles that are published with regard to possible prediction of intermediate syndrome using clinical, biochemical and electrophysiological parameters.
A systematic review on literature published in English language was done in the PubMed database without a date limitation. Two sets of search terms were used. The first set consisted of MeSH Terms "organophosphates", "organophosphate poisoning", "op poisoning" "organophosphate insecticide poisoning" and "organophosphorus". The second set included the MeSH Terms "Intermediate syndrome", "proximal muscle weakness", "cranial nerve palsies", "respiratory depression" and "neck muscle weakness". Articles containing at least one word from each set were reviewed.
At least one MeSH term from each set was incorporated in 179 articles. Of these, 69 were rejected as they were not related to organophosphate poisoning or intermediate syndrome.
Clinical prediction is mostly based on ICU scoring systems. Biochemical markers such as reduced levels of serum and erythrocyte acetylcholine esterase have been studied many times. Both clinical and biochemical markers show a modest relationship in predicting IMS. Single fibre electromyography show promising results as it directly assesses neuromuscular junction.
The intermediate syndrome which follows organophosphate poisoning still remains a significant problem with its high morbidity. Clinical and biochemical markers show modest results in predicting IMS. Neurophysiological markers such as single fibre EMG should be studied further as they measure activity of affected nicotinic receptors directly.
在发展中国家，有机磷杀虫剂（OPI）的摄入是故意自我伤害的常见方式。死亡主要是由于与胆碱能危象和中间综合征相关的呼吸衰竭所致。尽管通过早期对这些患者进行机械通气可以预防死亡，但关于中间综合征和随后的呼吸衰竭的预测，相关研究有限。
系统回顾有关使用临床、生化和电生理参数预测中间综合征的文章。
在 PubMed 数据库中进行了关于以英语发表的文献的系统综述，没有时间限制。使用了两组搜索词。第一组由 MeSH 术语“有机磷”、“有机磷中毒”、“OP 中毒”、“有机磷杀虫剂中毒”和“有机磷”组成。第二组包括 MeSH 术语“中间综合征”、“近端肌无力”、“颅神经麻痹”、“呼吸抑制”和“颈肌无力”。综述了包含每组至少一个词的文章。
每组至少有一个 MeSH 术语被纳入 179 篇文章中。其中，有 69 篇被拒绝，因为它们与有机磷中毒或中间综合征无关。
IMS 的预测：临床预测主要基于 ICU 评分系统。生化标志物如血清和红细胞乙酰胆碱酯酶水平降低已被多次研究。临床和生化标志物在预测 IMS 方面都显示出适度的关系。单纤维肌电图显示出有前途的结果，因为它直接评估神经肌肉接头。
有机磷中毒后仍存在中间综合征，其发病率较高仍是一个重大问题。临床和生化标志物在预测 IMS 方面的结果仅略有改善。神经生理标志物，如单纤维 EMG，应进一步研究，因为它们直接测量受影响的烟碱受体的活性。
