Bhalla Ashish, Jyothinath P, Singh Surjit
Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Crit Care Med. 2017 Dec;21(12):836-840. doi: 10.4103/0972-5229.220744.
N-acetyl cysteine (NAC) is a powerful antioxidant and has been used extensively in the treatment of paracetamol overdose with great success. Aluminum phosphide (ALP) ingestion results in significant oxidative stress. In this study, we evaluated the effects of NAC on mortality in patients with severe ALP poisoning.
This prospective intervention study was carried out in the emergency medical unit attached to the Nehru Hospital at PGIMER, Chandigarh, over a period of 1 year. All the patients presenting with severe ALP poisoning were randomized into two group. The treatment group received NAC in the dose of 150 mg/kg intravenous over 1 h, followed by 50 mg/kg over 4 h, followed by 100 mg/kg 16 h in 5% dextrose. The placebo group received 5% dextrose. The primary end point was mortality.
A total of 50 patients were recruited. The baseline parameters were comparable in both groups. The survivors in the treatment group received 19 g of NAC, but the nonsurvivors received only 12.15 g of NAC. The overall mortality in the study group was 88% with 87.5% mortality in the treatment group and 88.5% in the placebo group.
Antioxidant therapy in the form of NAC in severe ALP poisoning did not confer any survival benefit.
N-乙酰半胱氨酸（NAC）是一种强大的抗氧化剂，已广泛用于对乙酰氨基酚过量中毒的治疗并取得了巨大成功。磷化铝（ALP）摄入会导致显著的氧化应激。在本研究中，我们评估了NAC对重度ALP中毒患者死亡率的影响。
这项前瞻性干预研究在昌迪加尔PGIMER附属尼赫鲁医院的急诊医疗单元进行，为期1年。所有出现重度ALP中毒的患者被随机分为两组。治疗组接受剂量为150mg/kg的NAC静脉注射，1小时内完成，随后4小时内给予50mg/kg，接着在16小时内于5%葡萄糖溶液中给予100mg/kg。安慰剂组接受5%葡萄糖溶液。主要终点是死亡率。
共招募了50名患者。两组的基线参数具有可比性。治疗组的幸存者接受了19g的NAC，但非幸存者仅接受了12.15g的NAC。研究组的总体死亡率为88%，治疗组死亡率为87.5%，安慰剂组为88.5%。
在重度ALP中毒中，以NAC形式进行的抗氧化治疗未带来任何生存益处。
